Surgeon peer network characteristics and adoption of new imaging techniques in breast cancer: A study of perioperative MRI

Abstract

Background: Perioperative MRI has disseminated into breast cancer practice despite equivocal evidence. We used a novel social network approach to assess the relationship between the characteristics of surgeons’ patient-sharing networks and subsequent use of MRI. Methods: We identified a cohort of female patients with stage 0-III breast cancer from the Surveillance, Epidemiology, and End Results (SEER)-Medicare database. We used claims data from these patients and non-cancer patients from the 5% Medicare sample to identify peer groups of physicians who shared patients during 2004-2006 (T1). We used a multivariable hierarchical model to identify peer group characteristics associated with uptake of MRI in T2 (2007-2009) by surgeons who had not used MRI in T1. Results: Our T1 sample included 15 149 patients with breast cancer, treated by 2439 surgeons in 390 physician groups. During T1, 9.1% of patients received an MRI; the use of MRI varied from 0% to 100% (IQR 0%, 8.5%) across peer groups. After adjusting for clinical characteristics, patients treated by surgeons in groups with a higher proportion of primary care physicians (PCPs) in T1 were less likely to receive MRI in T2 (OR = 0.81 for 10% increase in PCPs, 95% CI = 0.71, 0.93). Surgeon transitivity (ie, clustering of surgeons) was significantly associated with MRI receipt (P = 0.013); patients whose surgeons were in groups with higher transitivity in T1 were more likely to receive MRI in T2 (OR = 1.29 for 10% increase in clustering, 95% CI = 1.06, 1.58). Conclusion: The characteristics of a surgeon's peer network are associated with their patients’ subsequent receipt of perioperative MRI.