Evaluating treatment variation for early stage breast cancer patients in Iowa: Physician characteristics and patient variables that influence surgical referral decisions.

摘要

The purpose of this study was to investigate possible factors associated with the low rates of breast-conserving surgery performed in Iowa. Study objectives focused on variables that potentially influenced surgical referrals by a woman's long-term medical doctor. Hypotheses were that long-term medical doctors who had graduated most recently, were affiliated with organized care systems, had more available interpersonal communication channels and whose channels were more heterophilous (the degree to which interacting physicians are different in knowledge about breast cancer treatment) would be more likely to refer to surgeons with a higher probability of performing breast-conserving surgery. Other known or suspected influences on treatment choice in early stage breast cancer were adjusted for and included patient age, stage of disease, tumor size, and patient distance to the nearest radiation facility.; The Iowa SEER database was used to identify Iowa women diagnosed with early stage breast cancer between the years 1989 and 1996 and who received surgical treatment. Long-term medical doctors and surgeons for these women also were identified from this database. The Iowa Physicians Inventory was used to provide information about physician characteristics for the long-term medical doctors identified from the Iowa SEER database.; A total of 3,192 cases were eligible for this study. Multivariate logistic regression analyses were conducted to evaluate long-term physician and practice characteristics to explain surgical referral behavior. The dependent variable was the probability the surgeon a breast cancer patient was referred to performed breast-conserving surgery during the year of breast cancer diagnosis.; This study found that practicing in a physician network or having a greater number of physicians practicing in the area was associated with an increased probability of referring a woman to a surgeon who prefers breast-conserving surgery. In addition, measures of heterophily, including having a more diverse group of specialists practicing in the area, was associated with referral to a surgeon who preferred breast-conserving surgery.; We conclude that surgical referral behavior of primary care physicians is impacted by the opportunities for interaction among physicians. Promoting interaction among physicians with different specialties may increase the diffusion of new behaviors into clinical practice.