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Computational and Mathematical Methods in Medicine
Volume 2014, Article ID 316935, 9 pages
http://dx.doi.org/10.1155/2014/316935
Research Article

Logic Regression for Provider Effects on Kidney Cancer Treatment Delivery

1Department of Biostatistics, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109, USA
2Center for Healthcare Outcomes & Policy, University of Michigan, 2800 Plymouth Road, Ann Arbor, MI 48105, USA
3Department of Urology, University of Michigan, 1500 E Medical Center Drive, Ann Arbor, MI 48109, USA

Received 9 January 2014; Accepted 28 February 2014; Published 27 March 2014

Academic Editor: Zhenyu Jia

Copyright © 2014 Mousumi Banerjee et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

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.