Dataset Information

An empiric approach to identifying physician peer groups from claims data: An example from breast cancer care.

ABSTRACT:

Objective

To develop an empiric approach for evaluating the performance of physician peer groups based on patient-sharing in administrative claims data.

Data sources

Surveillance, Epidemiology and End Results-Medicare linked dataset.

Study design

Applying social network theory, we constructed physician peer groups for patients with breast cancer. Under different assumptions of key parameter values-minimum patient volume for physician inclusion and minimum number of patients shared between physicians for a connection-we compared agreement in group membership between split samples during 2004-2006 (T1) (reliability) and agreement in group membership between T1 and 2007-2009 (T2) (stability). We also compared the results with those derived from randomly generated groups and to hospital affiliation-based groups.

Principal findings

The sample included 142 098 patients treated by 43 174 physicians in T1 and 136 680 patients treated by 51 515 physicians in T2. We identified parameter values that resulted in a median peer group reliability of 85.2 percent (Interquartile range (IQR) [0 percent, 96.2 percent]) and median stability of 73.7 percent (IQR [0 percent, 91.0 percent]). In contrast, stability of randomly assigned peer groups was 6.2 percent (IQR [0 percent, 21.0 percent]). Median overlap of empirical groups with hospital groups was 32.2 percent (IQR [12.1 percent, 59.2 percent]).

Conclusions

It is feasible to construct physician peer groups that are reliable, stable, and distinct from both randomly generated and hospital-based groups.

SUBMITTER: Herrin J

PROVIDER: S-EPMC6338298 | biostudies-literature | 2019 Feb

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

An empiric approach to identifying physician peer groups from claims data: An example from breast cancer care.

Herrin Jeph J Soulos Pamela R PR Xu Xiao X Gross Cary P CP Pollack Craig Evan CE

Health services research 20181128 1

<h4>Objective</h4>To develop an empiric approach for evaluating the performance of physician peer groups based on patient-sharing in administrative claims data.<h4>Data sources</h4>Surveillance, Epidemiology and End Results-Medicare linked dataset.<h4>Study design</h4>Applying social network theory, we constructed physician peer groups for patients with breast cancer. Under different assumptions of key parameter values-minimum patient volume for physician inclusion and minimum number of patients ...[more]

PMID: 30488484

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Project description:ImportancePeer relationships may motivate physicians to aspire to high professional standards but have not been a major focus of quality improvement efforts.ObjectiveTo determine whether peer relationships between primary care physicians (PCPs) and specialists formed during training motivate improved specialist care for patients.Design, setting, and participantsIn this quasi-experimental study, difference-in-differences analysis was used to estimate differences in experiences with specialist care reported by patients of the same PCP for specialists who did vs did not co-train with the PCP, controlling for any differences in patient ratings of the same specialists in the absence of co-training ties. Specialist visits resulting from PCP referrals from 2016 to 2019 in a large health system were analyzed, including a subset of undirected referrals in which PCPs did not specify a specialist. Data were collected from January 2016 to December 2019 and analyzed from March 2020 to October 2022.ExposureThe exposure was PCP-specialist overlap in training (medical school or postgraduate medical) at the same institution for at least 1 year (co-training).Main outcomes and measuresComposite patient experience rating of specialist care constructed from Press Ganey's Medical Practice Survey.ResultsOf 9920 specialist visits for 8655 patients (62.9% female; mean age, 57.4 years) with 502 specialists in 13 specialties, 3.1% (306) involved PCP-specialist dyads with a co-training tie. Co-training ties between PCPs and specialists were associated with a 9.0 percentage point higher adjusted composite patient rating of specialist care (95% CI, 5.6-12.4 percentage points; P < .001), analogous to improvement from the median to the 91st percentile of specialist performance. This association was stronger for PCP-specialist dyads with full temporal overlap in training (same class or cohort) and consistently strong for 9 of 10 patient experience items, including clarity of communication and engagement in shared decision-making. In secondary analyses of objective markers of altered specialist practice in an expanded sample of visits not limited by the availability of patient experience data, co-training was associated with changes in medication prescribing, suggesting behavioral changes beyond interpersonal communication. Patient characteristics varied minimally by co-training status of PCP-specialist dyads. Results were similar in analyses restricted to undirected referrals (in which PCPs did not specify a specialist). Concordance between PCPs and specialists in physician age, sex, medical school graduation year, and training institution (without requiring temporal overlap) was not associated with better care experiences.Conclusions and relevanceIn this quasi-experimental study, PCP-specialist co-training elicited changes in specialist care that substantially improved patient experiences, suggesting potential gains from strategies encouraging the formation of stronger physician-peer relationships.

Dataset Information

An empiric approach to identifying physician peer groups from claims data: An example from breast cancer care.

Objective

Data sources

Study design

Principal findings

Conclusions

Publications

An empiric approach to identifying physician peer groups from claims data: An example from breast cancer care.

Similar Datasets

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