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Contextual Differences in Cancer Care Provider Networks and the Adoption of Novel Innovations (307908)
Erika Moen, Geisel School of Medicine at Dartmouth – Dept. of Biomedical Data ScienceAndrew Schaefer, The Dartmouth Institute for Health Policy and Clinical Practice
VS Subrahmanian, Dartmouth College – Dept. of Computer Science
Thomas White, Dartmouth College – Dept. of Computer Science
*Ronnie Zipkin, Geisel School of Medicine at Dartmouth – Dept. of Biomedical Data Science
Keywords: breast cancer care, patient-sharing networks, diffusion of innovation
Recent work has shown peer exposure can be predictive of adoption of treatments via relationships within patient-sharing networks, which correspond to professional relationships in clinical practice. The Oncotype DX (ODX) genomic assay became a guideline-recommended prognostic test in 2007, due to its effectiveness in identifying recurrence risk in patients with early-stage, estrogen receptor-positive, node-negative breast cancers. Analyzing nationwide Medicare claims data from 2007 to 2014, we identified a cohort of patients over 65 years of age with incident breast cancer, using established claims-based algorithms. Assembling patient-sharing networks among providers, we identify tendencies of early prescribers of ODX towards increased levels of care coordination, care continuity, and connectedness to other providers, relative to non-adopters. Applying diffusion models, we also use network measures, sociodemographic & geospatial characteristics, and health system membership to evaluate dynamic spread of ODX adoption across providers. This work has implications for the study and prevention of healthcare disparities when introducing new treatments and innovations in cancer care.