Docs keep patients within hospital, despite collaborative care movement

Birds of a feather flock together. That was the outcome of a study published in the Journal of the American Medical Association (JAMA) yesterday, which found that physicians tend to share patients with other physicians with similar physician-level and patient-panel characteristics.

However, experts worry that isolated networks could stifle innovation and could have implications for accountable care organizations that require providers and payers to collaborate, Scripps Howard News Service reported.

Researchers called physicians' relationships "information-sharing networks" in which doctors share patients, information and even behaviors. Unlike formal organizational structures, such as practice groups affiliated with hospitals or health plans, these structures are informal but still can influence decision-making on a daily basis, according to the research announcement.

Boston's Harvard Medical School and Beth Israel Deaconess Medical Center researchers looked at Medicare administrative data from 2006 in 51 hospital referral regions. Physicians with ties to each other were more likely to be based at the same hospital, Medpage Today noted. For instance, doctors in Albuquerque, N.M., were mainly connected to physicians within their own hospitals and less likely to share patients with doctors affiliated with other hospitals, according to Scripps Howard.

"We know that doctors learn through other doctors," senior study author and Harvard professor Nicholas Christakis said in the article. "So, by examining these patient-sharing networks, we can see how innovations--new technology, new drugs, new practices such as test ordering--begin to diffuse throughout a network."

Doctors also are more likely to share patients if the patients share similar problems or racial backgrounds.

"Physicians thus tend to cluster together along attributes that characterize their own backgrounds and the clinical circumstances of their patients," the authors wrote.

Understanding how these informal patient-sharing networks provides insight into physician behavior, as well as hospital and national initiatives, "because it is likely that physicians are strongly influenced by their network of relationships with other physicians," researchers said.

For more information:
- read the Scripps Howard News Service article
- read the Medpage Today article
- here's the research announcement
- check out the JAMA study

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