Comput Math Methods Med - Logic regression for provider effects on kidney cancer treatment delivery.

Tópicos

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Resumo

In the delivery of medical and surgical care, often times complex interactions between patient, physician, and hospital factors influence practice patterns. This paper presents a novel application of logic regression in the context of kidney cancer treatment delivery. Using linked data from the National Cancer Institute's (NCI) Surveillance, Epidemiology, and End Results (SEER) program and Medicare we identified patients diagnosed with kidney cancer from 1995 to 2005. The primary endpoints in the study were use of innovative treatment modalities, namely, partial nephrectomy and laparoscopy. Logic regression allowed us to uncover the interplay between patient, provider, and practice environment variables, which would not be possible using standard regression approaches. We found that surgeons who graduated in or prior to 1980 despite having some academic affiliation, low volume surgeons in a non-NCI hospital, or surgeons in rural environment were significantly less likely to use laparoscopy. Surgeons with major academic affiliation and practising in HMO, hospital, or medical school based setting were significantly more likely to use partial nephrectomy. Results from our study can show efforts towards dismantling the barriers to adoption of innovative treatment modalities, ultimately improving the quality of care provided to patients with kidney cancer.

Resumo Limpo

deliveri medic surgic care often time complex interact patient physician hospit factor influenc practic pattern paper present novel applic logic regress context kidney cancer treatment deliveri use link data nation cancer institut nci surveil epidemiolog end result seer program medicar identifi patient diagnos kidney cancer primari endpoint studi use innov treatment modal name partial nephrectomi laparoscopi logic regress allow us uncov interplay patient provid practic environ variabl possibl use standard regress approach found surgeon graduat prior despit academ affili low volum surgeon nonnci hospit surgeon rural environ signific less like use laparoscopi surgeon major academ affili practis hmo hospit medic school base set signific like use partial nephrectomi result studi can show effort toward dismantl barrier adopt innov treatment modal ultim improv qualiti care provid patient kidney cancer

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