Unexplained variation in the clinical management of prostate cancer is recognized as an important problem in cancer treatment. To investigate potential explanations for this variation, the proposed project uses a social network analytic approach to model the connections that exist between physicians caring for patients with prostate cancer. This approach explicitly recognizes the clinical reality that many patients face: they see multiple physicians for their screening, diagnosis, treatment, and follow-up care across a range of clinical venues and at various times. Not only does each physician contribute to the type and quality of care patients receive but also the relationships between physicians within a geographical region may be an important and modifiable determinant of care.
The specific aims of this study are: (1) to map the connections between PCPs, urologists, and radiation oncologists as a network and examine whether specialists'positions in the network structure are related to their patient's prostate cancer treatment;(2) to determine whether the network structure helps explain observed differences in prostate cancer treatment between black and white men;and (3) to investigate the determinants of the network structure through a survey of PCPs about their referral decisions. To achieve these aims, this project uses SEER-Medicare claims data and a survey of PCPs. The SEER- Medicare sample consists of men with localized prostate cancer diagnosed from 1995-2005 and their associated PCP and specialist providers. The position of specialists in the cancer care networks will be quantitatively determined and the positions will be related to patient-level variation in the type and quality of cancer care and to racial differences in care. The survey of PCPs will elucidate the factors important in their referral decisions. Understanding observed variations may suggest ways that the network structure may be leveraged to improve quality in cancer care and reduce disparities in outcomes. The candidate, Craig Pollack, MD, MHS is an Assistant Professor in the Division of General Internal Medicine at Johns Hopkins School of Medicine with a joint appointment in the Department of Epidemiology and membership in the Sidney Kimmel Comprehensive Cancer Center. His long-term goal is to become an independent, grant-funded health services researcher in the field of cancer control. His short-term goals are to develop expertise in cancer prevention and control, network analysis, advanced health services research methods, and organizational theory and provider behavior. Dr. Pollack has assembled a mentoring team that includes national leaders in cancer research, urological cancer, health disparities, and network analysis. The proposed project provides Dr. Pollack with the training, mentoring, and resources to become a successful independent investigator dedicated to improving cancer care.

Public Health Relevance

Though prostate cancer is very common among older men, there exists a great deal of variation in how patients with early disease get treated. Using a technique called social network analysis, we examine how the connections and referral patterns between primary care physicians and specialists may influence the type, quality and equity of care that men receive.

National Institute of Health (NIH)
National Cancer Institute (NCI)
Academic/Teacher Award (ATA) (K07)
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Subcommittee G - Education (NCI)
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Perkins, Susan N
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Johns Hopkins University
Internal Medicine/Medicine
Schools of Medicine
United States
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Schoenborn, Nancy L; Lee, Kimberley; Pollack, Craig E et al. (2017) Older Adults' Views and Communication Preferences About Cancer Screening Cessation. JAMA Intern Med 177:1121-1128
Wong, Michelle S; Grande, David T; Mitra, Nandita et al. (2017) Racial Differences in Geographic Access to Medical Care as Measured by Patient Report and Geographic Information Systems. Med Care 55:817-822
Pollack, Craig E; Soulos, Pamela R; Herrin, Jeph et al. (2017) The Impact of Social Contagion on Physician Adoption of Advanced Imaging Tests in Breast Cancer. J Natl Cancer Inst 109:
Radhakrishnan, Archana; Nowak, Sarah A; Parker, Andrew M et al. (2017) Physician Breast Cancer Screening Recommendations Following Guideline Changes: Results of a National Survey. JAMA Intern Med 177:877-878
Jiang, Tammy; Stillson, Christian H; Pollack, Craig Evan et al. (2017) How Men with Prostate Cancer Choose Specialists: A Qualitative Study. J Am Board Fam Med 30:220-229
Radhakrishnan, Archana; Grande, David; Mitra, Nandita et al. (2017) Second opinions from urologists for prostate cancer: Who gets them, why, and their link to treatment. Cancer 123:1027-1034
Pollack, Craig Evan; Armstrong, Katrina A; Mitra, Nandita et al. (2017) A multidimensional view of racial differences in access to prostate cancer care. Cancer 123:4449-4457
Radhakrishnan, Archana; Grande, David; Ross, Michelle et al. (2017) When Primary Care Providers (PCPs) Help Patients Choose Prostate Cancer Treatment. J Am Board Fam Med 30:298-307
Roberts, Eric T; Pollack, Craig Evan (2016) Does Churning in Medicaid Affect Health Care Use? Med Care 54:483-9
Riggs, Kevin R; Segal, Jodi B; Shin, Eun Ji et al. (2016) Prevalence and Cost of Office Visits Prior to Colonoscopy for Colon Cancer Screening. JAMA 315:514-5

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