Evolving Delivery System and Market Factors and Their Influence on Physician Networks and Patient Care

In this issue of JAMA Internal Medicine, Landon and colleagues apply claims-based algorithms to identify and describe physician networks. Analyzing Medicare data, the authors use pairs of physicians who share patients during specific episodes of care to define distinct networks (called communities) of interconnected physicians. They then investigate whether these networks’ characteristics are associated with the cost and quality of care delivered to these physicians’ patients. They find that greater numbers of doctors connected to physicians through patient sharing and greater dispersal of patient care outside their physician’s network community are associated with increased care costs. Quality measures were not consistently associated with network characteristics, possibly because performance on claims-based process of care measures that were available for study (like diabetes monitoring) do not necessarily capture influences of the broader physician network, as some outcome measures might.