Referral Network Increases Physicians' Adoption of Active Surveillance for Localized Prostate Cancer: A...

Area of Science:

• Oncology
• Health Services Research
• Medical Informatics

Background:

• Physician referral networks significantly impact medical information dissemination and the adoption of novel treatment modalities.
• Understanding these networks is crucial for optimizing the diffusion of evidence-based practices in healthcare.

Purpose of the Study:

• To investigate the influence of urologists' referral network connections, specifically through primary care physicians, on the adoption of active surveillance for localized prostate cancer.
• To quantify the impact of external referral relationships on the uptake of a specific cancer management strategy.

Main Methods:

• Utilized a cross-sectional design analyzing SEER-Medicare data from 2001-2015.
• Developed a referral network index to quantify urologists' connections outside their immediate practice.
• Employed multinomial logistic regression, controlling for patient, urologist, and market characteristics, to estimate the likelihood of active surveillance adoption.

Main Results:

• A one standard deviation increase in a urologist's referral network index correlated with a 1.90 percentage point increase in the probability of adopting active surveillance.
• This effect was more pronounced after 2010, suggesting an accelerated diffusion following clinical guideline updates.
• Primary care physician connections demonstrated a significant role in this diffusion process.

Conclusions:

• Primary care physicians serve as vital information conduits, facilitating the rapid adoption of new treatment paradigms among specialists.
• Strengthening referral networks, particularly those involving primary care, can enhance the dissemination of innovative cancer care strategies.
• The findings highlight the importance of network structures in clinical practice evolution.