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The DOI matches its Crossref record; 25 of the 25 references it cites were found in a registry or an index.

Patient-Sharing Networks of Physicians and Health Care Utilization and Spending Among Medicare Beneficiaries

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Landon, Bruce E., Keating, Nancy L., Onnela, Jukka-Pekka, Zaslavsky, Alan M., Christakis, Nicholas A., O’Malley, A. James·2018·JAMA Internal Medicine
DOI 10.1001/jamainternmed.2017.5034PMC PMC5833496
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Abstract

Importance: Physicians are embedded in informal networks in which they share patients, information, and behaviors. Objective: We examined the association between physician network properties and health care spending, utilization, and quality of care among Medicare beneficiaries. Design, Setting, and Participants: In this cross-sectional study, we applied methods from social network analysis to Medicare administrative data from 2006 to 2010 for an average of 3 761 223 Medicare beneficiaries per year seen by 40 241 physicians practicing in 51 hospital referral regions (HRRs) to identify networks of physicians linked by shared patients. We improved on prior methods by restricting links to physicians who shared patients for distinct episodes of care, thereby excluding potentially spurious linkages between physicians treating common patients but for unrelated reasons. We also identified naturally occurring communities of more tightly linked physicians in each region. We examined the relationship between network properties measured in the prior year and outcomes in the subsequent year using regression models. Main Outcomes and Measures: Spending on total medical services, hospital, physician, and other services, use of services, and quality of care. Results: The mean patient age across the 5 years of study was 72.3 years and 58.5% of the participants were women. The mean age across communities of included physicians was 49 years and approximately 78% were men. Mean total annual spending per patient was $10 051. Total spending was higher for patients of physicians with more connections to other physicians ($1009 for a 1-standard deviation increase, P < .001) and more shared care outside of their community ($172, P < .001). Spending on inpatient care was slightly lower for patients of physicians whose communities had higher proportions of primary care physicians (-$38, P < .001). Patients cared for by physicians linked to more physicians also had more hospital admissions and days (0.02 and 0.18, respectively; both P < .001 for a 1-standard deviation increase in the number of connected physicians), more emergency visits (0.02, P < .001), more visits to specialists (0.37, P < .001), and more primary care visits (0.11, P < .001). Patients whose physicians' networks had more primary care physicians had more primary care visits (0.44, P < .001) and fewer specialist and emergency visits (-0.33 [P < .001] and -0.008 [P = .008], respectively). The various measures of quality were inconsistently related to the network measures. Conclusions and Relevance: Characteristics of physicians' networks and the position of physicians in the network were associated with overall spending and utilization of services for Medicare beneficiaries.

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  • One study of a random sample of Medicare beneficiaries from 50 U.S. hospital referral regions found an overall 30-day readmission rate of 18%.

    “Although not directly comparable, one study of a random sample of Medicare beneficiaries from 50 U.S. hospital referral regions found an overall 30‐day readmission rate of 18%. 872”

    From 2024 Alzheimer's disease facts and figures (2024) · cites this paper as [872]

    The Quality of Care section defines the measure as the fraction of hospitalized beneficiaries readmitted within 30 days, and the results table reports 18.3%, consistent with the quoted 18%. But Identifying the Sharing of Patients says the study used all eligible Medicare beneficiaries in 50 randomly sampled hospital referral regions, plus Boston—not a random sample of beneficiaries from only 50 regions. (LLM, conf=0.88)

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Research works printed but not linked: 2

  1. Wasserman S, Faust K. Network Analysis: Methods and Applications. New York: Cambridge University Press; 1994.
  2. Landon BE, Keating NL, Barnett ML, et al. Variation in patient-sharing networks of physicians across the United States. JAMA. 2012;308(3):265- 273.

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Metadata

Authors
Landon, B. E., Keating, N. L., Onnela, J.-P., Zaslavsky, A. M., Christakis, N. A., & O’Malley, A. J.
Affiliations
  • Beth Israel Deaconess Medical Center (US)
  • Brigham and Women's Hospital (US)
  • Harvard University (US)
  • Yale University (US)
  • Dartmouth Institute for Health Policy and Clinical Practice (US)
Corresponding author
Landon, Bruce E.
ORCID
Venue
JAMA Internal Medicine
Publisher
American Medical Association (AMA)
Published
2018-01-01
Volume
178
Issue
1
Pages
66
ISSN
2168-6106 (ISSN-L)
DOI
10.1001/jamainternmed.2017.5034
PMC
PMC5833496
OpenAlex
W2768797527
Cited by
99
References
25
Citations by year
2026: 6 · 2025: 9 · 2024: 5 · 2023: 12 · 2022: 12 · 2021: 15 · 2020: 17 · 2019: 17 · 2018: 5
FWCI
19.66
Type
journal article
Language
en
Open access
Locations
  • JAMA Internal Medicine (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • National Cancer Institute (R01CA174468, P30CA023108)
  • National Institute of Allergy and Infectious Diseases (R01AI051164)
Topics
  • Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Healthcare Policy and Management
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Healthcare Systems and Technology
  • Health Sciences › Medicine › Family Practice › Primary Care and Health Outcomes
Keywords
physician networks, patient sharing, Medicare beneficiaries, health care utilization, health care spending, quality of care, primary care, hospitalization, emergency department visits, specialist visits, social network analysis, network communities, hospital referral regions, health care costs, physician collaboration
MeSH terms
Aged, Cross-Sectional Studies, Health Expenditures, Female, Medicare, Humans, Male, Middle Aged, Patient Acceptance of Health Care, Physicians, Primary Health Care, Referral and Consultation, Retrospective Studies, United States, Fee-for-Service Plans, Community Networks

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