Physician referral patterns and racial disparities in total hip replacement: A network analysis approach.

Hassan M K Ghomrawi,Jason Owen-Smith,Michael L Parks,Russell J Funk,John M Hollingsworth,Shahadat Uddin

doi:10.1371/journal.pone.0193014

Abstract

BackgroundEfforts to reduce racial disparities in total hip replacement (THR) have focused mainly on patient behaviors. While these efforts are no doubt important, they ignore the potentially important role of provider- and system-level factors, which may be easier to modify. We aimed to determine whether the patterns of interaction among physicians around THR episodes differ in communities with low versus high concentrations of black residents.Materials and methodsWe analyzed national Medicare claims from 2008 to 2011, identifying all fee-for-service beneficiaries who underwent THR. Based on physician encounter data, we then mapped the physician referral networks at the hospitals where beneficiaries’ procedures were performed. Next, we measured two structural properties of these networks that could affect care coordination and information sharing: clustering, and the number of external ties. Finally, we estimated multivariate regression models to determine the relationship between the concentration of black residents in the community [as measured by the hospital service area (HSA)] served by a given network and each of these 2 network properties.ResultsOur sample included 336,506 beneficiaries (mean age 76.3 ± SD), 63.1% of whom were women. HSAs with higher concentrations of black residents tended to be more impoverished than those with lower concentrations. While HSAs with higher concentrations of black residents had, on average, more acute care beds and medical specialists, they had fewer surgeons per capita than those with lower concentrations. After adjusting for these differences, we found that HSAs with higher concentrations of black residents were served by physician referral networks that had significantly higher within-network clustering but fewer external ties.ConclusionsWe observed differences in the patterns of interaction among physicians around THR episodes in communities with low versus high concentrations of black residents. Studies investigating the impact of these differences on access to quality providers and on THR outcomes are needed.

Highlights

Over half a million total hip replacements (THRs) are performed each year
Differences, we found that hospital service area (HSA) with higher concentrations of black residents were served by physician referral networks that had significantly higher within-network clustering but fewer external ties
Studies investigating the impact of these differences on access to quality providers and on THR outcomes are needed

Summary

Introduction

Over half a million total hip replacements (THRs) are performed each year. is THR a common procedure, but it is highly effective for treatment of end-stage hip osteoarthritis (OA) [1]. Efforts to address racial disparities have focused mainly on changing black patients’ behaviors through educating them about the benefits of THR [6]. While these efforts are no doubt important, there is increasing interest in the potential role of provider- and health system-level factors, which may be easier to modify. Efforts to reduce racial disparities in total hip replacement (THR) have focused mainly on patient behaviors. While these efforts are no doubt important, they ignore the potentially important role of provider- and system-level factors, which may be easier to modify. We aimed to determine whether the patterns of interaction among physicians around THR episodes differ in communities with low versus high concentrations of black residents

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