Improving access to multidisciplinary cancer care and patient outcomes by targeting physician networks

Variation in health outcomes for cancer patients has garnered significant national media attention. Recent retrospective cohort studies have reported that cancer health outcomes are improved and more consistent when patients have uniform access to care, highlighting the critical clinical importance of optimizing access to cancer care. Data made available which evaluates access to cancer specialists typically determines access based on a per capita count of individual specialties, which does not adequately capture access to multidisciplinary teams of specialists. A relatively unexplored area of study is the extent to which relationships between cancer specialists can be characterized and then targeted to optimize access to cancer care and improve patient outcomes. By assessing the relationships between physicians based on patient-sharing patterns observed in administrative data, we propose to apply our team’s expertise in network analysis, health services research and cancer care to provide a framework for evaluating patient access to cancer care which recognizes the coordination across medical oncology, radiation oncology, and surgical specialists. We have developed a novel network measure– linchpin score – which identifies cancer specialists who are the only specialist of their kind among their neighbors’ ties. We have demonstrated that patients treated by linchpin oncologists are more likely to have delayed cancer treatment and often experience worse survival. This proposal will build on our prior work by examining how network-based measures of access to cancer care, including linchpin score, are associated with patient healthcare resource utilization and patient experience measures. We will also provide resources to the scientific community in the forms of an R package and an interactive dashboard of aggregate oncology workforce measures. In conclusion, this proposal uses network analysis to capture essential characteristics of access to cancer care, with the long-term goal of using network-guided strategies to improve access to cancer care and patient outcomes.