A study of physician collaborations through social network and exponential random graph

Abstract

BackgroundPhysician collaboration, which evolves among physicians during the course of providing healthcare services to hospitalised patients, has been seen crucial to effective patient outcomes in healthcare organisations and hospitals. This study aims to explore physician collaborations using measures of social network analysis (SNA) and exponential random graph (ERG) model.MethodsBased on the underlying assumption that collaborations evolve among physicians when they visit a common hospitalised patient, this study first proposes an approach to map collaboration network among physicians from the details of their visits to patients. This paper terms this network as physician collaboration network (PCN). Second, SNA measures of degree centralisation, betweenness centralisation and density are used to examine the impact of SNA measures on hospitalisation cost and readmission rate. As a control variable, the impact of patient age on the relation between network measures (i.e. degree centralisation, betweenness centralisation and density) and hospital outcome variables (i.e. hospitalisation cost and readmission rate) are also explored. Finally, ERG models are developed to identify micro-level structural properties of (i) high-cost versus low-cost PCN; and (ii) high-readmission rate versus low-readmission rate PCN. An electronic health insurance claim dataset of a very large Australian health insurance organisation is utilised to construct and explore PCN in this study.ResultsIt is revealed that the density of PCN is positively correlated with hospitalisation cost and readmission rate. In contrast, betweenness centralisation is found negatively correlated with hospitalisation cost and readmission rate. Degree centralisation shows a negative correlation with readmission rate, but does not show any correlation with hospitalisation cost. Patient age does not have any impact for the relation of SNA measures with hospitalisation cost and hospital readmission rate. The 2-star parameter of ERG model has significant impact on hospitalisation cost. Furthermore, it is found that alternative-k-star and alternative-k-two-path parameters of ERG model have impact on readmission rate.ConclusionsCollaboration structures among physicians affect hospitalisation cost and hospital readmission rate. The implications of the findings of this study in terms of their potentiality in developing guidelines to improve the performance of collaborative environments among healthcare professionals within healthcare organisations are discussed in this paper.

Network collaboration of organizations for homeless individuals in the Montreal region

“…This group plays a liaison role between the Montreal homeless organisations [1]. A high density can have positive, but also negative aspects [43, 52]. It might indicate the existence of shared values and beliefs among members of the Montreal homeless organisation network, which facilitate information sharing and decision-making [43].…”

“…Studies that focused on the link between collaboration and user outcomes have arrived at conflicting results. Some studies revealed that collaboration between organisations or professionals would increase patient satisfaction [52] and reduce death rates [53], length of hospital stays and hospitalisation costs [54, 55]. Other studies have indicated, however, that other factors such as stability or level of funding can affect the positive association between integration and outcome [7, 56].…”

“…Moreover, performance of a network can be compromised if its density is too high. For example, in a study on a physician collaboration network, Uddin et al [52] found that density increased hospitalisation costs and readmission rates. As the number of organisations in a network increases, it becomes more difficult for them to work harmoniously [14].…”

Social Networks of Professionals in Health Care Organizations

“…Centralization of a network of collaboration of physicians around a dominant actor has been found instead to be negatively related to performance, in terms of both higher hospitalization cost and higher rate of patients' readmission to hospital (Uddin et al, 2013).…”

The social network around influenza vaccination in health care workers: a cross-sectional study

“…There are increasing numbers of studies combining different types of social networks and health [5–7], with scope for possible network interventions [8]. In health care settings [9–11], these have been used to analyze hierarchies and positions in the network [12, 13], their relationship with hospitalization costs and readmission rates [14], information seeking [15, 16], the adoption of best practices [17], and homophily in advice and friendship networks, the tendency of individuals to associate and bond with similar others [18, 19]. Social networks may play a role in the adoption of health behaviors and practices [20], and homophily, in particular, has been shown to have an effect [21, 22].…”