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Cohen-Mekelburg S, Yu X, Costa D, Hofer TP, Krein S, Hollingsworth J, Wiitala W, Saini S, Zhu J, Waljee A. Variation in Provider Connectedness Associates With Outcomes of Inflammatory Bowel Diseases in an Analysis of Data From a National Health System. Clin Gastroenterol Hepatol 2021; 19:2302-2311.e1. [PMID: 32798705 PMCID: PMC9131729 DOI: 10.1016/j.cgh.2020.08.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 07/28/2020] [Accepted: 08/11/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Inflammatory bowel diseases (IBD) often require multidisciplinary care with tight coordination among providers. Provider connectedness, a measure of the relationship among providers, is an important aspect of care coordination that has been linked to higher quality care. We aimed to assess variation in provider connectedness among medical centers, and to understand the association between this established measure of care coordination and outcomes of patients with IBD. METHODS We conducted a national cohort study of 32,949 IBD patients with IBD from 2005 to 2014. We used network analysis to examine provider connectedness, defined using network properties that measure the strength of the collaborative relationship, team cohesiveness, and between-facility collaborations. We used multilevel modeling to examine variations in provider connectedness and association with patient outcomes. RESULTS There was wide variation in provider connectedness among facilities in complexity, rural designation, and volume of patients with IBD. In a multivariable model, patients followed in a facility with team cohesiveness (odds ratio, 0.38; 95% CI, 0.16-0.88) and where providers often collaborated with providers outside their facility (odds ratio, 0.48; 95% CI, 0.31-0.75) were less likely to have clinically active disease, defined by a composite of outpatient flare, inpatient flare, and IBD-related surgery. CONCLUSIONS A national study found evidence for heterogeneity in patient-sharing among IBD care teams. Patients with IBD seen at health centers with higher provider connectedness appear to have better outcomes. Understanding provider connectedness is a step toward designing network-based interventions to improve coordination and quality of care.
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Affiliation(s)
- Shirley Cohen-Mekelburg
- Division of Gastroenterology & Hepatology, University of Michigan, Ann Arbor, Michigan; VA Center for Clinical Management Research, Ann Arbor, Michigan; Institute of Health Policy and Innovation, University of Michigan, Ann Arbor, Michigan.
| | - Xianshi Yu
- Department of Statistics, University of Michigan, Ann Arbor, Michigan
| | - Deena Costa
- Institute of Health Policy and Innovation, University of Michigan, Ann Arbor, Michigan, University of Michigan School of Nursing, Ann Arbor, Michigan
| | - Timothy P. Hofer
- VA Center for Clinical Management Research, Ann Arbor, Michigan, Institute of Health Policy and Innovation, University of Michigan, Ann Arbor, Michigan, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Sarah Krein
- VA Center for Clinical Management Research, Ann Arbor, Michigan, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - John Hollingsworth
- Institute of Health Policy and Innovation, University of Michigan, Ann Arbor, Michigan, Department of Urology, University of Michigan, Ann Arbor, Michigan
| | - Wyndy Wiitala
- VA Center for Clinical Management Research, Ann Arbor, Michigan
| | - Sameer Saini
- Division of Gastroenterology & Hepatology, University of Michigan, Ann Arbor, Michigan, VA Center for Clinical Management Research, Ann Arbor, Michigan, Institute of Health Policy and Innovation, University of Michigan, Ann Arbor, Michigan
| | - Ji Zhu
- Department of Statistics, University of Michigan, Ann Arbor, Michigan
| | - Akbar Waljee
- Division of Gastroenterology & Hepatology, University of Michigan, Ann Arbor, Michigan, VA Center for Clinical Management Research, Ann Arbor, Michigan, Institute of Health Policy and Innovation, University of Michigan, Ann Arbor, Michigan
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Engels PT, Coates A, MacDonald RD, Ahghari M, Welsford M, Dodd T, Turcotte K, Doyle JD, Eugenio AM, Green JP, Irvine JE, Lysecki PJ, Sandhanwalia SK, Sharma SV. Toward an all-inclusive trauma system in Central South Ontario: development of the Trauma-System Performance Improvement and Knowledge Exchange (T-SPIKE) project. Can J Surg 2021; 64:E162-E172. [PMID: 33720676 PMCID: PMC8064245 DOI: 10.1503/cjs.000820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background There is currently no integrated data system to capture the true burden of injury and its management within Ontario’s regional trauma networks (RTNs), largely owing to difficulties in identifying these patients across the multiple health care provider records. Our project represents an iterative effort to create the ability to chart the course of care for all injured patients within the Central South RTN. Methods Through broad stakeholder engagement of major health care provider organizations within the Central South RTN, we obtained research ethics board approval and established data-sharing agreements with multiple agencies. We tested identification of trauma cases from Jan. 1 to Dec. 31, 2017, and methods to link patient records between the various echelons of care to identify barriers to linkage and opportunities for administrative solutions. Results During 2017, potential trauma cases were identified within ground paramedic services (23 107 records), air medical transport services (196 records), referring hospitals (7194 records) and the lead trauma hospital trauma registry (1134 records). Linkage rates for medical records between services ranged from 49% to 92%. Conclusion We successfully conceptualized and provided a preliminary demonstration of an initiative to collect, collate and accurately link primary data from acute trauma care providers for certain patients injured within the Central South RTN. Administration-level changes to the capture and management of trauma data represent the greatest opportunity for improvement.
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Affiliation(s)
- Paul T Engels
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Engels, Coates, Doyle, Sharma); the Trauma Program, Hamilton Health Sciences, Hamilton, Ont. (Engels, Coates, Sharma); Ornge, Mississauga, Ont. (MacDonald); the Department of Medicine, University of Toronto, Toronto, Ont. (MacDonald, Ahghari); the Centre for Paramedic Education and Research, Stoney Creek, Ont. (Welsford, Dodd, Turcotte); the Division of Emergency Medicine, McMaster University, Hamilton, Ont. (Welsford); Niagara Health, St. Catharines, Ont. (Doyle); Cambridge Memorial Hospital, Cambridge, Ont. (Eugenio); Grand River Hospital, Kitchener-Waterloo, Ont. (Green); Brantford General Hospital, Brantford, Ont. (Irvine); Joseph Brant Hospital, Burlington, Ont. (Lysecki); and Oakville Trafalgar Memorial Hospital, Oakville, Ont. (Sandhanwalia)
| | - Angela Coates
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Engels, Coates, Doyle, Sharma); the Trauma Program, Hamilton Health Sciences, Hamilton, Ont. (Engels, Coates, Sharma); Ornge, Mississauga, Ont. (MacDonald); the Department of Medicine, University of Toronto, Toronto, Ont. (MacDonald, Ahghari); the Centre for Paramedic Education and Research, Stoney Creek, Ont. (Welsford, Dodd, Turcotte); the Division of Emergency Medicine, McMaster University, Hamilton, Ont. (Welsford); Niagara Health, St. Catharines, Ont. (Doyle); Cambridge Memorial Hospital, Cambridge, Ont. (Eugenio); Grand River Hospital, Kitchener-Waterloo, Ont. (Green); Brantford General Hospital, Brantford, Ont. (Irvine); Joseph Brant Hospital, Burlington, Ont. (Lysecki); and Oakville Trafalgar Memorial Hospital, Oakville, Ont. (Sandhanwalia)
| | - Russell D MacDonald
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Engels, Coates, Doyle, Sharma); the Trauma Program, Hamilton Health Sciences, Hamilton, Ont. (Engels, Coates, Sharma); Ornge, Mississauga, Ont. (MacDonald); the Department of Medicine, University of Toronto, Toronto, Ont. (MacDonald, Ahghari); the Centre for Paramedic Education and Research, Stoney Creek, Ont. (Welsford, Dodd, Turcotte); the Division of Emergency Medicine, McMaster University, Hamilton, Ont. (Welsford); Niagara Health, St. Catharines, Ont. (Doyle); Cambridge Memorial Hospital, Cambridge, Ont. (Eugenio); Grand River Hospital, Kitchener-Waterloo, Ont. (Green); Brantford General Hospital, Brantford, Ont. (Irvine); Joseph Brant Hospital, Burlington, Ont. (Lysecki); and Oakville Trafalgar Memorial Hospital, Oakville, Ont. (Sandhanwalia)
| | - Mahvareh Ahghari
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Engels, Coates, Doyle, Sharma); the Trauma Program, Hamilton Health Sciences, Hamilton, Ont. (Engels, Coates, Sharma); Ornge, Mississauga, Ont. (MacDonald); the Department of Medicine, University of Toronto, Toronto, Ont. (MacDonald, Ahghari); the Centre for Paramedic Education and Research, Stoney Creek, Ont. (Welsford, Dodd, Turcotte); the Division of Emergency Medicine, McMaster University, Hamilton, Ont. (Welsford); Niagara Health, St. Catharines, Ont. (Doyle); Cambridge Memorial Hospital, Cambridge, Ont. (Eugenio); Grand River Hospital, Kitchener-Waterloo, Ont. (Green); Brantford General Hospital, Brantford, Ont. (Irvine); Joseph Brant Hospital, Burlington, Ont. (Lysecki); and Oakville Trafalgar Memorial Hospital, Oakville, Ont. (Sandhanwalia)
| | - Michelle Welsford
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Engels, Coates, Doyle, Sharma); the Trauma Program, Hamilton Health Sciences, Hamilton, Ont. (Engels, Coates, Sharma); Ornge, Mississauga, Ont. (MacDonald); the Department of Medicine, University of Toronto, Toronto, Ont. (MacDonald, Ahghari); the Centre for Paramedic Education and Research, Stoney Creek, Ont. (Welsford, Dodd, Turcotte); the Division of Emergency Medicine, McMaster University, Hamilton, Ont. (Welsford); Niagara Health, St. Catharines, Ont. (Doyle); Cambridge Memorial Hospital, Cambridge, Ont. (Eugenio); Grand River Hospital, Kitchener-Waterloo, Ont. (Green); Brantford General Hospital, Brantford, Ont. (Irvine); Joseph Brant Hospital, Burlington, Ont. (Lysecki); and Oakville Trafalgar Memorial Hospital, Oakville, Ont. (Sandhanwalia)
| | - Tim Dodd
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Engels, Coates, Doyle, Sharma); the Trauma Program, Hamilton Health Sciences, Hamilton, Ont. (Engels, Coates, Sharma); Ornge, Mississauga, Ont. (MacDonald); the Department of Medicine, University of Toronto, Toronto, Ont. (MacDonald, Ahghari); the Centre for Paramedic Education and Research, Stoney Creek, Ont. (Welsford, Dodd, Turcotte); the Division of Emergency Medicine, McMaster University, Hamilton, Ont. (Welsford); Niagara Health, St. Catharines, Ont. (Doyle); Cambridge Memorial Hospital, Cambridge, Ont. (Eugenio); Grand River Hospital, Kitchener-Waterloo, Ont. (Green); Brantford General Hospital, Brantford, Ont. (Irvine); Joseph Brant Hospital, Burlington, Ont. (Lysecki); and Oakville Trafalgar Memorial Hospital, Oakville, Ont. (Sandhanwalia)
| | - Katie Turcotte
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Engels, Coates, Doyle, Sharma); the Trauma Program, Hamilton Health Sciences, Hamilton, Ont. (Engels, Coates, Sharma); Ornge, Mississauga, Ont. (MacDonald); the Department of Medicine, University of Toronto, Toronto, Ont. (MacDonald, Ahghari); the Centre for Paramedic Education and Research, Stoney Creek, Ont. (Welsford, Dodd, Turcotte); the Division of Emergency Medicine, McMaster University, Hamilton, Ont. (Welsford); Niagara Health, St. Catharines, Ont. (Doyle); Cambridge Memorial Hospital, Cambridge, Ont. (Eugenio); Grand River Hospital, Kitchener-Waterloo, Ont. (Green); Brantford General Hospital, Brantford, Ont. (Irvine); Joseph Brant Hospital, Burlington, Ont. (Lysecki); and Oakville Trafalgar Memorial Hospital, Oakville, Ont. (Sandhanwalia)
| | - Jeffrey D Doyle
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Engels, Coates, Doyle, Sharma); the Trauma Program, Hamilton Health Sciences, Hamilton, Ont. (Engels, Coates, Sharma); Ornge, Mississauga, Ont. (MacDonald); the Department of Medicine, University of Toronto, Toronto, Ont. (MacDonald, Ahghari); the Centre for Paramedic Education and Research, Stoney Creek, Ont. (Welsford, Dodd, Turcotte); the Division of Emergency Medicine, McMaster University, Hamilton, Ont. (Welsford); Niagara Health, St. Catharines, Ont. (Doyle); Cambridge Memorial Hospital, Cambridge, Ont. (Eugenio); Grand River Hospital, Kitchener-Waterloo, Ont. (Green); Brantford General Hospital, Brantford, Ont. (Irvine); Joseph Brant Hospital, Burlington, Ont. (Lysecki); and Oakville Trafalgar Memorial Hospital, Oakville, Ont. (Sandhanwalia)
| | - Arthur M Eugenio
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Engels, Coates, Doyle, Sharma); the Trauma Program, Hamilton Health Sciences, Hamilton, Ont. (Engels, Coates, Sharma); Ornge, Mississauga, Ont. (MacDonald); the Department of Medicine, University of Toronto, Toronto, Ont. (MacDonald, Ahghari); the Centre for Paramedic Education and Research, Stoney Creek, Ont. (Welsford, Dodd, Turcotte); the Division of Emergency Medicine, McMaster University, Hamilton, Ont. (Welsford); Niagara Health, St. Catharines, Ont. (Doyle); Cambridge Memorial Hospital, Cambridge, Ont. (Eugenio); Grand River Hospital, Kitchener-Waterloo, Ont. (Green); Brantford General Hospital, Brantford, Ont. (Irvine); Joseph Brant Hospital, Burlington, Ont. (Lysecki); and Oakville Trafalgar Memorial Hospital, Oakville, Ont. (Sandhanwalia)
| | - Jason P Green
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Engels, Coates, Doyle, Sharma); the Trauma Program, Hamilton Health Sciences, Hamilton, Ont. (Engels, Coates, Sharma); Ornge, Mississauga, Ont. (MacDonald); the Department of Medicine, University of Toronto, Toronto, Ont. (MacDonald, Ahghari); the Centre for Paramedic Education and Research, Stoney Creek, Ont. (Welsford, Dodd, Turcotte); the Division of Emergency Medicine, McMaster University, Hamilton, Ont. (Welsford); Niagara Health, St. Catharines, Ont. (Doyle); Cambridge Memorial Hospital, Cambridge, Ont. (Eugenio); Grand River Hospital, Kitchener-Waterloo, Ont. (Green); Brantford General Hospital, Brantford, Ont. (Irvine); Joseph Brant Hospital, Burlington, Ont. (Lysecki); and Oakville Trafalgar Memorial Hospital, Oakville, Ont. (Sandhanwalia)
| | - J Eric Irvine
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Engels, Coates, Doyle, Sharma); the Trauma Program, Hamilton Health Sciences, Hamilton, Ont. (Engels, Coates, Sharma); Ornge, Mississauga, Ont. (MacDonald); the Department of Medicine, University of Toronto, Toronto, Ont. (MacDonald, Ahghari); the Centre for Paramedic Education and Research, Stoney Creek, Ont. (Welsford, Dodd, Turcotte); the Division of Emergency Medicine, McMaster University, Hamilton, Ont. (Welsford); Niagara Health, St. Catharines, Ont. (Doyle); Cambridge Memorial Hospital, Cambridge, Ont. (Eugenio); Grand River Hospital, Kitchener-Waterloo, Ont. (Green); Brantford General Hospital, Brantford, Ont. (Irvine); Joseph Brant Hospital, Burlington, Ont. (Lysecki); and Oakville Trafalgar Memorial Hospital, Oakville, Ont. (Sandhanwalia)
| | - Paul J Lysecki
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Engels, Coates, Doyle, Sharma); the Trauma Program, Hamilton Health Sciences, Hamilton, Ont. (Engels, Coates, Sharma); Ornge, Mississauga, Ont. (MacDonald); the Department of Medicine, University of Toronto, Toronto, Ont. (MacDonald, Ahghari); the Centre for Paramedic Education and Research, Stoney Creek, Ont. (Welsford, Dodd, Turcotte); the Division of Emergency Medicine, McMaster University, Hamilton, Ont. (Welsford); Niagara Health, St. Catharines, Ont. (Doyle); Cambridge Memorial Hospital, Cambridge, Ont. (Eugenio); Grand River Hospital, Kitchener-Waterloo, Ont. (Green); Brantford General Hospital, Brantford, Ont. (Irvine); Joseph Brant Hospital, Burlington, Ont. (Lysecki); and Oakville Trafalgar Memorial Hospital, Oakville, Ont. (Sandhanwalia)
| | - Simerpreet K Sandhanwalia
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Engels, Coates, Doyle, Sharma); the Trauma Program, Hamilton Health Sciences, Hamilton, Ont. (Engels, Coates, Sharma); Ornge, Mississauga, Ont. (MacDonald); the Department of Medicine, University of Toronto, Toronto, Ont. (MacDonald, Ahghari); the Centre for Paramedic Education and Research, Stoney Creek, Ont. (Welsford, Dodd, Turcotte); the Division of Emergency Medicine, McMaster University, Hamilton, Ont. (Welsford); Niagara Health, St. Catharines, Ont. (Doyle); Cambridge Memorial Hospital, Cambridge, Ont. (Eugenio); Grand River Hospital, Kitchener-Waterloo, Ont. (Green); Brantford General Hospital, Brantford, Ont. (Irvine); Joseph Brant Hospital, Burlington, Ont. (Lysecki); and Oakville Trafalgar Memorial Hospital, Oakville, Ont. (Sandhanwalia)
| | - Sunjay V Sharma
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Engels, Coates, Doyle, Sharma); the Trauma Program, Hamilton Health Sciences, Hamilton, Ont. (Engels, Coates, Sharma); Ornge, Mississauga, Ont. (MacDonald); the Department of Medicine, University of Toronto, Toronto, Ont. (MacDonald, Ahghari); the Centre for Paramedic Education and Research, Stoney Creek, Ont. (Welsford, Dodd, Turcotte); the Division of Emergency Medicine, McMaster University, Hamilton, Ont. (Welsford); Niagara Health, St. Catharines, Ont. (Doyle); Cambridge Memorial Hospital, Cambridge, Ont. (Eugenio); Grand River Hospital, Kitchener-Waterloo, Ont. (Green); Brantford General Hospital, Brantford, Ont. (Irvine); Joseph Brant Hospital, Burlington, Ont. (Lysecki); and Oakville Trafalgar Memorial Hospital, Oakville, Ont. (Sandhanwalia)
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