Evaluating Breast Cancer Care Coordination at a Rural National Cancer Institute Comprehensive Cancer Center Using Network Analysis and Geospatial Methods

Background:Variation in cancer care coordination may impact care quality and patient outcomes. We sought to characterize the impact of geographic access to and dispersion of cancer care providers on variation in care coordination. Methods:Using electronic health record data from 2,507 women diagnosed with breast cancer at a National Cancer Institute Comprehensive Cancer Center from April 2011 to September 2015, a breast cancer patient-sharing physician network was constructed. Patient "care networks" represent the sub-networks of physicians with whom the focal patient had a clinical encounter. Patient care networks were analyzed to generate two measures of care coordination, care density (ratio of observed vs potential connections between physicians) and clustering (extent to which physicians form connected triangles). Results:The breast cancer physician network included 667 physicians. On average, the physicians shared patients with 12 other physicians. Patients saw an average of 8 physicians during active treatment. In multivariable models adjusting for patient sociodemographic and clinical characteristics, we observed that greater travel burden (>2 hours) and lower geographic dispersion was associated with higher care density (p<0.05 and p<0.001, respectively) but lower care network clustering (p<0.05). Conclusions:Variation in network-based measures of care coordination is partially explained by patient travel burden and geographic dispersion of care. Impact:Improved understanding of factors driving variation in patient care networks may identify patients at risk of receiving poorly coordinated cancer care.