Research

Published:

(2015)  Hollingsworth, John M., Russell J. Funk, Spencer A. Garrison, Jason Owen-Smith, Bruce E. Landon, and John D. Birkmeyer.  “Differences Between Physician Social Networks for Cardiac Surgery Serving Communities with High Versus Low Proportions of Black Residents.”  Medical Care 53(2):  pp. 160-167.

  • Compared to white patients, black patients–particularly those residing in racially-segregated areas–are more likely to undergo cardiac surgery at low-quality hospitals, even when they live closer to high-quality ones.  The mechanisms underlying this tendency remain unclear.  Our objective in this paper is to explore physician referral network dynamics in differentially-segregated areas as a potential explanation for racial disparities in access to high-quality hospitals for cardiac surgery.  Using national Medicare data for coronary artery bypass grafting (CABG) procedures performed between 2008 and 2011, we mapped physician social networks at the hospitals where such procedures were performed, characterizing these networks across a range of structural properties that we believe to have an impact on successful coordination and information sharing.  After accounting for regional differences in health care capacity and resources, the social networks of physicians practicing in highly segregated areas were determined to vary in many important respects from those observed in hospital service areas with low segregation.  When physicians in these areas interact with one another, they tend to assemble in smaller groups (p < 0.001), and generally maintain fewer relationships with physicians outside of their immediate practice (p < 0.001).  The structures of physician social networks formed around CABG patients in hospital service areas with high and low segregation differ in ways that may relate to care coordination and information sharing.  These findings suggest that planned health system reforms encouraging patients of color to seek care within established local networks may exacerbate disparities in the quality of the surgical care such patients receive.

Forthcoming/Under Review:

(2016)  Garrison, Spencer A.  “‘Not Trans Enough’:  Negotiating Authenticity in Lifetime Narratives of Gender Experience.”  Under review at Social Psychology Quarterly.

  • In order to claim a transgender identity label, gender non-conforming individuals must first ‘come out’ to others, narrating their experience of gender in ways that others understand to be culturally credible.  As a consequence, many trans-identified individuals express concern about whether their own lifetime experience of gender can be distilled into a narrative that is intelligible to others and that appears consistent over time.  Drawing upon a series of in-depth interviews with transgender and gender non-conforming adults, I identify a series of narrative devices that respondents employ to account for inconsistencies within their lifetime narratives of gender experience.  Cultural and interactional constraints work to distinguish narratives that are ‘trans enough’ from those which are not, facilitating some types of gender-variant identity and body projects while inhibiting or discrediting others.  My findings suggest that the ongoing threat of identity challenge leads many gender-variant individuals to revise, adapt, or re-interpret their gender narratives across the life course — a process which may have significant implications for the ways in which such individuals come to understand their identities and to make decisions about social and physical transition.

(2016)  Hollingsworth, John M., Russell J. Funk, Spencer A. Garrison, Jason Owen-Smith, Samuel A. Kaufman, Francis D. Pagiani, and Brahmajee K. Nallamothu.  “Association Between Physician Teamwork and Health System Outcomes Following Coronary Artery Bypass Grafting.”  Under review at Circulation.

  • Surgical outcomes after coronary artery bypass grafting (CABG) vary significantly across hospitals in the U.S., even after adjusting for case-mix differences between patients.  As health system leaders continue to struggle with this variation, some suggest that part of the problem relates to the one-dimensional nature of these initiatives, which primarily target surgeons’ activities in the operating room and individual activities immediately afterward.  In an alternative framework, CABG may best be viewed as a “team sport,” whereby patients rely on multiple providers in partnership with the surgeon, dispersed across a variety of care locations.  In situations where physicians do not communicate and share information, ambiguity can arise around treatment roles and accountability, lapses in care transfer can ensue, and conflicting advice may be offered.  Yet, while team-building has emerged as a strategy for enhancing performance in the outpatient setting, its potential association with surgical outcomes remains unclear.  In this context, we analyzed national data from Medicare beneficiaries who underwent CABG.  We used network analysis to characterize the level of teamwork among surgeons and non-surgeons in the health systems where these procedures were performed.  We then compared surgical outcomes across health systems, stratifying by their teamwork level.  Findings from our study serve to inform hospitals and health system leaders about the possible effects of healthcare reforms designed to foster physician team building — most notably the patient-centered medical home, bundled payments, and accountable care organizations (ACOs) — on surgical outcomes.

In Preparation:

(2016)  Hoffman, Charity, Spencer Garrison, Angela Perone, and Elizabeth Armstrong.  “Is This a Relationship, or a ‘Situationship?’  Making Sense of the Search for Sex, Love, and Intimacy at Mid-Life.”

  • Despite ongoing cultural prescriptions to get married and stay married, growing numbers of American women find themselves single at mid-adulthood.  While these women share a common identity as “singles,” their experiences and interpretations of what it means to be single are diverse.  In this article, we draw upon qualitative data from in-depth interviews with 56 women between the ages of 35 and 55 to assess how single women at mid-adulthood make sense of their status as single, and to explore how differing interpretations of singlehood work to shape women’s pursuit of new sexual and romantic partners.  We argue that different women arrive at different understandings of what it means to be “single” at mid-life, and that these understandings shape how women perceive risk and opportunity in their intimate relationships, influencing long-term ideals and aspirations.  We find that, rather than being inherently associated with heightened risks — for example, the risk of poverty (Vespa 2013), risks to emotional or physical health (Waite 2005), or the risk of social stigma (DePaulo 2008) — staying single can actually serve as a means of defending against the equivalent risk of entering into a committed relationship.

 

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