1
|
Whiteside JL, Tumin D, Hohmann SF, Harris A. Determinants of Cost for Outpatient Hysterectomy for Benign Indications in a Nationwide Sample. Obstet Gynecol 2023; 141:765-772. [PMID: 36897129 DOI: 10.1097/aog.0000000000005109] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 12/22/2022] [Indexed: 03/11/2023]
Abstract
OBJECTIVE To identify surgeon-level variation in cost to produce an outpatient hysterectomy for benign indications in the United States. METHODS A sample of patients undergoing outpatient hysterectomy in October 2015 to December 2021, excluding those with a diagnosis of gynecologic malignancy, was obtained from the Vizient Clinical Database. The primary outcome was total direct hysterectomy cost, which is a modeled cost to produce care. Patient, hospital, and surgeon covariates were analyzed with mixed-effects regression, which included surgeon-level random effects to capture unobserved differences influencing cost variation. RESULTS The final sample included 264,717 cases performed by 5,153 surgeons. The median total direct cost of hysterectomy was $4,705 (interquartile range $3,522-6,234). Cost was highest for robotic hysterectomy ($5,412) and lowest for vaginal hysterectomy ($4,147). After all variables were included in the regression model, approach was the strongest of the observed predictors, but 60.5% of the variance in costs was attributable to unexplained surgeon-level differences, implying a difference in costs between the 10th and 90th percentiles of surgeons of $4,063. CONCLUSION The largest observed determinant of cost to produce an outpatient hysterectomy for benign indications in the United States is approach, but differences in cost are attributable primarily to unexplained differences among surgeons. Standardization of surgical approach and technique and surgeon awareness of surgical supply costs could address these unexplained cost variations.
Collapse
Affiliation(s)
- James L Whiteside
- Department of Obstetrics and Gynecology and the Department of Pediatrics, East Carolina University, Brody School of Medicine, Greenville, North Carolina, and Vizient Inc, Center for Advanced Analytics and Informatics, and the Department of Health Systems Management, Rush University, Chicago, Illinois
| | | | | | | |
Collapse
|
2
|
Ssegujja E, Ddumba I, Andipatin M. Health workers' social networks and their influence in the adoption of strategies to address the stillbirth burden at a subnational level health system in Uganda. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000798. [PMID: 36962455 PMCID: PMC10021602 DOI: 10.1371/journal.pgph.0000798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 06/27/2022] [Indexed: 11/18/2022]
Abstract
Health workers' peer networks are known to influence members' behaviours and practices while translating policies into service delivery. However, little remains known about the extent to which this remains true within interventions aimed at addressing the stillbirth burden in low-resource settings like Uganda. The objective of this study was to examine the health workers' social networks and their influence on the adoption of strategies to address the stillbirth burden at a subnational level health system in Uganda. A qualitative exploratory design was adopted on a purposively selected sample of 16 key informants. The study was conducted in Mukono district among sub-national health systems, managers, health facility in-charges, and frontline health workers. Data was collected using semi-structured interview guides in a face-to-face interview with respondents. The analysis adopted a thematic approach utilising Atlas. ti software for data management. Participants acknowledged that workplace social networks were influential during the implementation of policies to address stillbirth. The influence exerted was in form of linkage with other services, caution, and advice regarding strict adherence to policy recommendations perhaps reflective of the level of trust in providers' ability to adhere to policy provisions. At the district health management level and among non-state actors, support in perceived areas of weak performance in policy implementation was observed. In addition, timely initiation of contact and subsequent referral was another aspect where health workers exerted influence while translating policies to address the stillbirth burden. While the level of support from among network peers was observed to influence health workers' adoption and implementation of strategies to address the stillbirth burden, different mechanisms triggered subsequent response and level of adherence to recommended policy aspects. Drawing from the elicited responses, we infer that health workers' social networks influence the direction and extent of success in policy implementation to address the stillbirth burden at the subnational level.
Collapse
Affiliation(s)
- Eric Ssegujja
- Department of Health Policy Planning and Management, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
- Faculty of Community and Health Sciences, School of Public Health, University of the Western Cape, Cape Town, Republic of South Africa
| | - Isaac Ddumba
- Department of Health, Mukono District Local Government, Mukono, Uganda
| | - Michelle Andipatin
- Faculty of Community and Health Sciences, Department of Psychology, University of the Western Cape, Cape Town, Republic of South Africa
| |
Collapse
|
3
|
Leapman MS, Wang R, Park HS, Yu JB, Sprenkle PC, Dinan MA, Ma X, Gross CP. Adoption of New Risk Stratification Technologies Within US Hospital Referral Regions and Association With Prostate Cancer Management. JAMA Netw Open 2021; 4:e2128646. [PMID: 34623406 PMCID: PMC8501394 DOI: 10.1001/jamanetworkopen.2021.28646] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
IMPORTANCE The clinical decisions that arise from prostate magnetic resonance imaging (MRI) and genomic testing in patients with prostate cancer are not well understood. OBJECTIVE To evaluate the association between regional uptake of prostate MRI and genomic testing and observation vs treatment for prostate cancer. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study of commercial insurance claims for prostate MRI and genomic testing included 65 530 patients 40 to 89 years of age newly diagnosed with prostate cancer from July 1, 2012, through June 30, 2019. EXPOSURES Patient- and regional-level use of prostate MRI and genomic testing. MAIN OUTCOMES AND MEASURES Observation vs definitive treatment for prostate cancer. Patient-level analyses examined the association between receipt of testing or residing in a hospital referral region (HRR) that adopted testing and observation. In regional-level analyses, the dependent variable was the change in the proportion of patients observed for prostate cancer at the HRR level between 2 periods: July 1, 2012, to June 30, 2014, and July 1, 2017, to June 20, 2019. The independent study variables included HRR-level changes in the proportion of men undergoing prostate MRI and genomic testing between these periods, and the models were adjusted for contextual factors associated with prostate cancer care and socioeconomic status. RESULTS This study identified 65 530 patients, including 27 679 in the early period (mean [SD] age, 58.0 [5.9] years) and 37 851 in the late period (mean [SD] age, 59.0 [5.7] years). Use of prostate MRI increased significantly from 7.2% (95% CI, 6.9%-7.5%) to 16.7% (95% CI, 16.3%-17.1%) from the early to late period. Use of genomic testing increased significantly from 1.3% (95% CI, 1.1%-1.4%) to 12.7% (95% CI, 12.3%-13.0%) from the early to late period. Compared with the lowest, the highest HRR quartiles of prostate MRI and genomic testing uptake were associated with an adjusted 4.1% (SE, 1.1%; P < .001) and 2.5% (SE, 1.1%; P = .03) absolute increase in the proportion of patients receiving observation, respectively. CONCLUSIONS AND RELEVANCE In this cohort study, uptake of prostate MRI and genomic testing was associated with increased use of initial observation vs treatment for prostate cancer. Marked geographic variation supports the need for further patient-level research to optimize the dissemination and outcome of testing.
Collapse
Affiliation(s)
- Michael S. Leapman
- Department of Urology, Yale School of Medicine, New Haven, Connecticut
- Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, New Haven, Connecticut
| | - Rong Wang
- Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, New Haven, Connecticut
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
| | - Henry S. Park
- Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, New Haven, Connecticut
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut
| | - James B. Yu
- Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, New Haven, Connecticut
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut
| | | | - Michaela A. Dinan
- Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, New Haven, Connecticut
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
| | - Xiaomei Ma
- Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, New Haven, Connecticut
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
| | - Cary P. Gross
- Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, New Haven, Connecticut
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| |
Collapse
|
4
|
Nemesure MD, Schwedhelm TM, Sacerdote S, O’Malley AJ, Rozema LR, Moen EL. A measure of local uniqueness to identify linchpins in a social network with node attributes. APPLIED NETWORK SCIENCE 2021; 6:56. [PMID: 34938853 PMCID: PMC8691752 DOI: 10.1007/s41109-021-00400-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 07/02/2021] [Indexed: 06/14/2023]
Abstract
Network centrality measures assign importance to influential or key nodes in a network based on the topological structure of the underlying adjacency matrix. In this work, we define the importance of a node in a network as being dependent on whether it is the only one of its kind among its neighbors' ties. We introduce linchpin score, a measure of local uniqueness used to identify important nodes by assessing both network structure and a node attribute. We explore linchpin score by attribute type and examine relationships between linchpin score and other established network centrality measures (degree, betweenness, closeness, and eigenvector centrality). To assess the utility of this measure in a real-world application, we measured the linchpin score of physicians in patient-sharing networks to identify and characterize important physicians based on being locally unique for their specialty. We hypothesized that linchpin score would identify indispensable physicians who would not be easily replaced by another physician of their specialty type if they were to be removed from the network. We explored differences in rural and urban physicians by linchpin score compared with other network centrality measures in patient-sharing networks representing the 306 hospital referral regions in the United States. We show that linchpin score is uniquely able to make the distinction that rural specialists, but not rural general practitioners, are indispensable for rural patient care. Linchpin score reveals a novel aspect of network importance that can provide important insight into the vulnerability of health care provider networks. More broadly, applications of linchpin score may be relevant for the analysis of social networks where interdisciplinary collaboration is important.
Collapse
Affiliation(s)
- Matthew D. Nemesure
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, NH 03756
| | - Thomas M. Schwedhelm
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, NH 03756
| | | | - A. James O’Malley
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, NH 03756
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH 03756
| | - Luke R. Rozema
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, NH 03756
| | - Erika L. Moen
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, NH 03756
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH 03756
| |
Collapse
|
5
|
Xu X, Soulos PR, Herrin J, Wang S, Pollack CE, Evans SB, Yu JB, Gross CP. Physician trajectories of abandoning long-course breast radiotherapy and their cost impact. Health Serv Res 2021; 56:497-506. [PMID: 33070305 PMCID: PMC8143683 DOI: 10.1111/1475-6773.13572] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To examine variation in trajectories of abandoning conventionally fractionated whole-breast irradiation (CF-WBI) for adjuvant breast radiotherapy among physician peer groups and the associated cost implications. DATA SOURCES Medicare claims data were obtained from the Chronic Conditions Data Warehouse for fee-for-service beneficiaries with breast cancer in 2011-2014. STUDY DESIGN We used social network methods to identify peer groups of physicians that shared patients. For each physician peer group in each time period (T1 = 2011-2012 and T2 = 2013-2014), we calculated a risk-adjusted rate of CF-WBI use among eligible women, after adjusting for patient clinical characteristics. We applied a latent class growth analysis to these risk-adjusted rates to identify distinct trajectories of CF-WBI use among physician peer groups. We further estimated potential savings to the Medicare program by accelerating abandonment of CF-WBI in T2 using a simulation model. DATA COLLECTION/EXTRACTION METHODS Use of conventionally fractionated whole-breast irradiation was determined from Medicare claims among women ≥ 66 years of age who underwent adjuvant radiotherapy after breast conserving surgery. PRINCIPAL FINDINGS Among 215 physician peer groups caring for 16 988 patients, there were four distinct trajectories of abandoning CF-WBI: (a) persistent high use (mean risk-adjusted utilization rate: T1 = 94.3%, T2 = 90.6%); (b) decreased high use (T1 = 81.3%, T2 = 65.3%); (c) decreased medium use (T1 = 60.1%, T2 = 44.0%); and (d) decreased low use (T1 = 31.6%, T2 = 23.6%). Peer groups with a smaller proportion of patients treated at free-standing radiation facilities and a larger proportion of physicians that were surgeons tended to follow trajectories with lower use of CF-WBI. If all physician peer groups had practice patterns in T2 similar to those in the "decreased low use" trajectory, the Medicare program could save $83.3 million (95% confidence interval: $58.5 million-$112.2 million). CONCLUSIONS Physician peer groups had distinct trajectories of abandoning CF-WBI. Physician composition and setting of radiotherapy were associated with the different trajectories. Distinct practice patterns across the trajectories had important cost implications.
Collapse
Affiliation(s)
- Xiao Xu
- Department of Obstetrics, Gynecology and Reproductive SciencesYale School of MedicineNew HavenConnecticutUSA
- Yale Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) CenterYale School of MedicineNew HavenConnecticutUSA
| | - Pamela R. Soulos
- Yale Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) CenterYale School of MedicineNew HavenConnecticutUSA
- Section of General Internal MedicineDepartment of Internal MedicineYale School of MedicineNew HavenConnecticutUSA
| | - Jeph Herrin
- Yale Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) CenterYale School of MedicineNew HavenConnecticutUSA
- Section of CardiologyDepartment of Internal MedicineYale School of MedicineNew HavenConnecticutUSA
| | - Shi‐Yi Wang
- Yale Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) CenterYale School of MedicineNew HavenConnecticutUSA
- Department of Chronic Disease EpidemiologyYale School of Public HealthNew HavenConnecticutUSA
| | - Craig Evan Pollack
- Department of Health Policy and ManagementJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
- Department of MedicineJohns Hopkins School of MedicineBaltimoreMarylandUSA
| | - Suzanne B. Evans
- Department of Therapeutic RadiologyYale School of MedicineNew HavenConnecticutUSA
| | - James B. Yu
- Yale Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) CenterYale School of MedicineNew HavenConnecticutUSA
- Department of Therapeutic RadiologyYale School of MedicineNew HavenConnecticutUSA
| | - Cary P. Gross
- Yale Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) CenterYale School of MedicineNew HavenConnecticutUSA
- Section of General Internal MedicineDepartment of Internal MedicineYale School of MedicineNew HavenConnecticutUSA
| |
Collapse
|
6
|
Poss-Doering R, Kühn L, Kamradt M, Stürmlinger A, Glassen K, Andres E, Kaufmann-Kolle P, Wambach V, Bader L, Szecsenyi J, Wensing M. Fostering Appropriate Antibiotic Use in a Complex Intervention: Mixed-Methods Process Evaluation Alongside the Cluster-Randomized Trial ARena. Antibiotics (Basel) 2020; 9:E878. [PMID: 33302559 PMCID: PMC7764260 DOI: 10.3390/antibiotics9120878] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 12/03/2020] [Accepted: 12/07/2020] [Indexed: 01/04/2023] Open
Abstract
The cluster randomized trial ARena (sustainable reduction of antibiotic-induced antimicrobial resistance, 2017-2020) promoted appropriate use of antibiotics for acute non-complicated infections in primary care networks (PCNs) in Germany. A process evaluation assessed determinants of practice and explored factors associated with antibiotic prescribing patterns. This work describes its findings on uptake and impacts of the complex intervention program and indicates potential implementation into routine care. In a nested mixed-methods approach, a three-wave study-specific survey for participating physicians and medical assistants assessed potential impacts and uptake of the complex intervention program. Stakeholders received a one-time online questionnaire to reflect on network-related aspects. Semi-structured, open-ended interviews, with a purposive sample of physicians, medical assistants and stakeholders, explored program component acceptance for daily practice and perceived sustainability of intervention component effects. Intervention components were perceived to be smoothly integrable into practice routines. The highest uptake was reported for educational components: feedback reports, background information, e-learning modules and disease-specific quality circles (QCs). Participation in PCNs was seen as the motivational factor for guideline-oriented patient care and adoption of new routines. Future approaches to fostering appropriate antibiotics use by targeting health literacy competencies and clinician's therapy decisions should combine evidence-based information sources, audit and feedback reports and QCs.
Collapse
Affiliation(s)
- Regina Poss-Doering
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany; (L.K.); (M.K.); (A.S.); (K.G.); (J.S.); (M.W.)
| | - Lukas Kühn
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany; (L.K.); (M.K.); (A.S.); (K.G.); (J.S.); (M.W.)
| | - Martina Kamradt
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany; (L.K.); (M.K.); (A.S.); (K.G.); (J.S.); (M.W.)
| | - Anna Stürmlinger
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany; (L.K.); (M.K.); (A.S.); (K.G.); (J.S.); (M.W.)
| | - Katharina Glassen
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany; (L.K.); (M.K.); (A.S.); (K.G.); (J.S.); (M.W.)
| | - Edith Andres
- aQua Institut, Maschmuehlenweg 8-10, 37073 Goettingen, Germany; (E.A.); (P.K.-K.)
| | - Petra Kaufmann-Kolle
- aQua Institut, Maschmuehlenweg 8-10, 37073 Goettingen, Germany; (E.A.); (P.K.-K.)
| | - Veit Wambach
- Agentur deutscher Arztnetze e.V., Friedrichstraße 171, 10117 Berlin, Germany;
| | - Lutz Bader
- Kassenärztliche Vereinigung Bayerns (KVB), 80684 München, Germany;
| | - Joachim Szecsenyi
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany; (L.K.); (M.K.); (A.S.); (K.G.); (J.S.); (M.W.)
- aQua Institut, Maschmuehlenweg 8-10, 37073 Goettingen, Germany; (E.A.); (P.K.-K.)
| | - Michel Wensing
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany; (L.K.); (M.K.); (A.S.); (K.G.); (J.S.); (M.W.)
| |
Collapse
|
7
|
Poss-Doering R, Kamradt M, Glassen K, Andres E, Kaufmann-Kolle P, Wensing M. Promoting rational antibiotic prescribing for non-complicated infections: understanding social influence in primary care networks in Germany. BMC FAMILY PRACTICE 2020; 21:51. [PMID: 32171252 PMCID: PMC7073012 DOI: 10.1186/s12875-020-01119-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 02/28/2020] [Indexed: 11/22/2022]
Abstract
Background Primary care networks in Germany are formalized regional collaborations of physicians and other healthcare providers. Common goals are optimized healthcare processes and services for patients, enhanced communication, agency for professional concerns and strengthened economic power. In the ARena study (Sustainable reduction of antibiotic-induced antimicrobial resistance), 14 primary care networks in two federal German states aimed to promote appropriate antibiotics use for acute non-complicated infections by fostering awareness and understanding. Factors related to the role of primary care networks were to be identified. Methods For this study, audio-recorded telephone interviews were conducted with physicians, non-physician health professionals and stakeholder representatives. Pseudonymized verbatim transcripts were coded using thematic analysis. In-depth analysis was based on the inductive categories ‘social support’, ‘social learning’, ‘social normative pressures’ and ‘social contagion’ to reflect social influence processes. Data generated through a survey with physicians and non-physician health professionals were analyzed descriptively to foster understanding of the networks’ potential impact on antibiotic prescribing. Results Social influence processes proved to be relevant regarding knowledge transfer, manifestation of best-practice care and self-reflection. Peer communication was seen as a great asset, the main reason for membership and affirmative for own perspectives. All interviewed physicians (n = 27) considered their network to be a strong support factor for daily routines, introduction of new routines, and continuity of care. They utilized network-offered training programs focusing on best practice guideline-oriented use of antibiotics and considered their networks supportive in dealing with patient expectations. A shared attitude combined with ARena intervention components facilitated reflective management of antibiotic prescribing. Non-physician health professionals (n = 11) also valued network peer exchange. They assumed their employers joined networks to offer improved and continuous care. Stakeholders (n = 7) expected networks and their members to be drivers for care optimization. Conclusion Primary care networks play a crucial role in providing a platform for professional peer exchange, social support and reassurance. With regards to their impact on antibiotic prescribing for acute non-complicated infections, networks seem to facilitate and amplify quality improvement programs by providing a platform for refreshing awareness, knowledge and self-reflection among care providers. They are well suited to promote a rational use of antibiotics. Trial registration ISRCTN, ISRCTN58150046. Registered 24 August 2017.
Collapse
Affiliation(s)
- Regina Poss-Doering
- Dept. of General Practice and Health Services Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany.
| | - Martina Kamradt
- Dept. of General Practice and Health Services Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Katharina Glassen
- Dept. of General Practice and Health Services Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Edith Andres
- aQua Institut, Maschmuehlenweg 8-10, 37073, Goettingen, Germany
| | | | - Michel Wensing
- Dept. of General Practice and Health Services Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| |
Collapse
|
8
|
Ostovari M, Steele-Morris CJ, Griffin PM, Yu D. Data-driven modeling of diabetes care teams using social network analysis. J Am Med Inform Assoc 2019; 26:911-919. [PMID: 31045227 PMCID: PMC7647209 DOI: 10.1093/jamia/ocz022] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 01/24/2019] [Accepted: 02/13/2019] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE We assess working relationships and collaborations within and between diabetes health care provider teams using social network analysis and a multi-scale community detection. MATERIALS AND METHODS Retrospective analysis of claims data from a large employer over 2 years was performed. The study cohort contained 827 patients diagnosed with diabetes. The cohort received care from 2567 and 2541 health care providers in the first and second year, respectively. Social network analysis was used to identify networks of health care providers involved in the care of patients with diabetes. A multi-scale community detection was applied to the network to identify groups of health care providers more densely connected. Social network analysis metrics identified influential providers for the overall network and for each community of providers. RESULTS Centrality measures identified medical laboratories and mail-order pharmacies as the central providers for the 2 years. Seventy-six percent of the detected communities included primary care physicians, and 97% of the communities included specialists. Pharmacists were detected as central providers in 24% of the communities. DISCUSSION Social network analysis measures identified the central providers in the network of diabetes health care providers. These providers could be considered as influencers in the network that could enhance the implication of promotion programs through their access to a large number of patients and providers. CONCLUSION The proposed framework provides multi-scale metrics for assessing care team relationships. These metrics can be used by implementation experts to identify influential providers for care interventions and by health service researchers to determine impact of team relationships on patient outcomes.
Collapse
Affiliation(s)
- Mina Ostovari
- School of Industrial Engineering, Purdue University, West Lafayette, Indiana, USA
| | | | - Paul M Griffin
- School of Industrial Engineering, Purdue University, West Lafayette, Indiana, USA
- Regenstrief Center for Health care Engineering, Gerald D. and Edna E. Mann Hall, West Lafayette, Indiana, USA
| | - Denny Yu
- School of Industrial Engineering, Purdue University, West Lafayette, Indiana, USA
| |
Collapse
|
9
|
Tannenbaum SS, Soulos PR, Herrin J, Pollack CE, Xu X, Christakis NA, Forman HP, Yu JB, Killelea BK, Wang SY, Gross CP. Surgeon peer network characteristics and adoption of new imaging techniques in breast cancer: A study of perioperative MRI. Cancer Med 2018; 7:5901-5909. [PMID: 30444005 PMCID: PMC6308117 DOI: 10.1002/cam4.1821] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 09/17/2018] [Accepted: 09/18/2018] [Indexed: 11/28/2022] Open
Abstract
Background Perioperative MRI has disseminated into breast cancer practice despite equivocal evidence. We used a novel social network approach to assess the relationship between the characteristics of surgeons’ patient‐sharing networks and subsequent use of MRI. Methods We identified a cohort of female patients with stage 0‐III breast cancer from the Surveillance, Epidemiology, and End Results (SEER)‐Medicare database. We used claims data from these patients and non‐cancer patients from the 5% Medicare sample to identify peer groups of physicians who shared patients during 2004‐2006 (T1). We used a multivariable hierarchical model to identify peer group characteristics associated with uptake of MRI in T2 (2007‐2009) by surgeons who had not used MRI in T1. Results Our T1 sample included 15 149 patients with breast cancer, treated by 2439 surgeons in 390 physician groups. During T1, 9.1% of patients received an MRI; the use of MRI varied from 0% to 100% (IQR 0%, 8.5%) across peer groups. After adjusting for clinical characteristics, patients treated by surgeons in groups with a higher proportion of primary care physicians (PCPs) in T1 were less likely to receive MRI in T2 (OR = 0.81 for 10% increase in PCPs, 95% CI = 0.71, 0.93). Surgeon transitivity (ie, clustering of surgeons) was significantly associated with MRI receipt (P = 0.013); patients whose surgeons were in groups with higher transitivity in T1 were more likely to receive MRI in T2 (OR = 1.29 for 10% increase in clustering, 95% CI = 1.06, 1.58). Conclusion The characteristics of a surgeon's peer network are associated with their patients’ subsequent receipt of perioperative MRI.
Collapse
Affiliation(s)
| | - Pamela R Soulos
- Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, Yale Cancer Center and Yale School of Medicine, New Haven, Connecticut.,Section of General Internal Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Jeph Herrin
- Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, Yale Cancer Center and Yale School of Medicine, New Haven, Connecticut.,Section of Cardiology, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut.,Health Research & Educational Trust, Chicago, Illinois
| | - Craig E Pollack
- Johns Hopkins School of Medicine, Baltimore, Maryland.,Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Xiao Xu
- Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, Yale Cancer Center and Yale School of Medicine, New Haven, Connecticut.,Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut
| | - Nicholas A Christakis
- Department of Sociology, Yale University, New Haven, Connecticut.,Yale Institute for Network Science and Human Nature Lab, Yale University, New Haven, Connecticut
| | - Howard P Forman
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut
| | - James B Yu
- Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, Yale Cancer Center and Yale School of Medicine, New Haven, Connecticut.,Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut
| | - Brigid K Killelea
- Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, Yale Cancer Center and Yale School of Medicine, New Haven, Connecticut.,Department of Surgery, Yale School of Medicine, New Haven, Connecticut.,Yale Cancer Center, New Haven, Connecticut
| | - Shi-Yi Wang
- Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, Yale Cancer Center and Yale School of Medicine, New Haven, Connecticut.,Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
| | - Cary P Gross
- Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, Yale Cancer Center and Yale School of Medicine, New Haven, Connecticut.,Section of General Internal Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| |
Collapse
|