Physicians, both directly through services they provide and indirectly through the services that they order,shape the vast majority of health care utilization in the U.S. There has long been interest in the determinantsof physician decision-making because optimizing physician decisions has the potential to improve the qualityof U.S. health care while also controlling costs by eliminating the use of unnecessary services. Oneinfluence on physician decision-making that has largely been ignored, however, has been physicians'position in the larger networks of doctors. In this setting, 'networks' refer to informal networks of primarycare and specialist physicians who share patients and information rather than to formal networks of all of thephysicians formally affiliated with a health plan or hospital. In practice, each physician, particularly eachprimary care physician, develops distinct sets of specialist physicians with whom they share patients andinformation. By virtue of sharing patients, these networks can be defined empirically. These networks ofphysicians in turn have the potential to influence an individual physician's decision making, and suchinfluences may vary depending on the structure of the network and/or occurrences within the network. Inthis project, we aim to improve our understanding of this phenomenon. We also aim to explore thecontribution of network properties to observed variations in spending and treatment patterns within theMedicare program. Our proposal has the following specific aims: (1) to create and describe a dataset aboutphysician networks using comprehensive national data from the Medicare program regarding over 10 millionpeople and up to 150,000 doctors; (2) to identify the characteristics of different types of hospitals andregional hospital markets that are associated with physician networks and to examine the extent to whichformal organizations influence the formation of informal networks; (3) to examine the characteristics ofindividual primary care and specialist physicians that are associated with properties of physician-centeredand geographically delimited physician networks; and (4) to evaluate the contribution of physician networksto variations in health spending and the use of particular health care services (e.g., hospice care) accordingto geographic regions. The role of networks and the extent to which network connections influence theclinical decisions made by individual physicians is unknown. A better understanding of this complexphenomenon will improve our ability to influence physician decision making to improve quality and decreasecosts and provide novel insights into the role that provider connections play in the delivery of health care.
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