Physician Networks and Ambulatory Care-sensitive Admissions

In networks with higher levels of reinforcement and clustering, physicians perceive stronger teamwork, perhaps because the strong ties between them create a shared understanding; however, sharing patients with more physicians overall (i.e., density) did not lead to stronger teamwork. Clinical and organizational leaders may consider designing the structure of clinical teams to increase interactions with known colleagues and repeated interactions between providers.

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“…; Casalino et al. ). Our findings suggest that network structure may help by improving the team's ability to work together.…”

Section: Discussionmentioning

confidence: 98%

Repeated, Close Physician Coronary Artery Bypass Grafting Teams Associated with Greater Teamwork

Everson

Funk

Kaufman

et al. 2017

Health Services Research

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“…23,24 Although findings from these studies are, no doubt, important, their relevance to surgical patients, like those undergoing CABG, is unclear. Few would expect teamwork among physicians to have a measurable impact on operative complications, which are major drivers of health services utilization in the postdischarge period.…”

Section: Discussionmentioning

confidence: 99%

Association Between Physician Teamwork and Health System Outcomes After Coronary Artery Bypass Grafting

Hollingsworth

Funk

Garrison

et al. 2016

Circ: Cardiovascular Quality and Outcomes

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Background-Patients undergoing coronary artery bypass grafting (CABG) must often see multiple providers dispersed across many care locations. To test whether teamwork (assessed with the bipartite clustering coefficient) among these physicians is a determinant of surgical outcomes, we examined national Medicare data from patients undergoing CABG. Methods and Results-Among Medicare beneficiaries who underwent CABG between 2008 and 2011, we mapped relationships between all physicians who treated them during their surgical episodes, including both surgeons and nonsurgeons. After aggregating across CABG episodes in a year to construct the physician social networks serving each health system, we then assessed the level of physician teamwork in these networks with the bipartite clustering coefficient. Finally, we fit a series of multivariable regression models to evaluate associations between a health system's teamwork level and its 60-day surgical outcomes. We observed substantial variation in the level of teamwork between health systems performing CABG (SD for the bipartite clustering coefficient was 0.09). Although health systems with high and low teamwork levels treated beneficiaries with comparable comorbidity scores, these health systems differed over several sociocultural and healthcare capacity factors (eg, physician staff size and surgical caseload). After controlling for these differences, health systems with higher teamwork levels had significantly lower 60-day rates of emergency department visit, readmission, and mortality. Conclusions-Health systems with physicians who tend to work together in tightly-knit groups during CABG episodes realize better surgical outcomes. As such, delivery system reforms focused on building teamwork may have positive effects on surgical care. (Circ Cardiovasc Qual Outcomes. 2016;9:641-648.

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“…Unlike the widely used definitions, CDAs leverage patterns of interactions between entities to define maximally distinct groups whose members are highly connected but share few connections outside the group, resulting in high potential validity. The value of this approach in health care has recently been demonstrated in studies that placed physicians and other organization into groups . In these studies, physician groups have been defined by applying a CDA to networks based on physicians treating the same patients, reasoning that patient sharing may lead to similar physician practice patterns and reflect broad referral patterns.…”

Section: Introductionmentioning

confidence: 99%

Comparing methods of grouping hospitals

Everson

Hollingsworth

Adler‐Milstein

2019

Health Services Research

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Objective To compare the performance of widely used approaches for defining groups of hospitals and a new approach based on network analysis of shared patient volume. Study Setting Non‐federal acute care hospitals in the United States. Study Design We assessed the measurement properties of four methods of grouping hospitals: hospital referral regions (HRRs), metropolitan statistical areas (MSAs), core‐based statistical areas (CBSAs), and community detection algorithms (CDAs). Data Extraction Methods We combined data from the 2014 American Hospital Association Annual Survey, the Census Bureau, the Dartmouth Atlas, and Medicare data on interhospital patient travel patterns. We then evaluated the distinctiveness of each grouping, reliability over time, and generalizability across populations. Principle Findings Hospital groups defined by CDAs were the most distinctive (modularity = 0.86 compared to 0.75 for HRRs and 0.83 for MSAs; 0.72 for CBSA), were reliable to alternative specifications, and had greater generalizability than HRRs, MSAs, or CBSAs. CDAs had lower reliability over time than MSAs or CBSAs (normalized mutual information between 2012 and 2014 CDAs = 0.93). Conclusions Community detection algorithm‐defined hospital groups offer high validity, reliability to different specifications, and generalizability to many uses when compared to approaches in widespread use today. They may, therefore, offer a better choice for efforts seeking to analyze the behaviors and dynamics of groups of hospitals. Measures of modularity, shared information, inclusivity, and shared behavior can be used to evaluate different approaches to grouping providers.

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Physician Networks and Ambulatory Care-sensitive Admissions

Abstract: Physician networks have a relationship with ACSAs that is independent of the physicians in the network. Physician networks could be an important focus for understanding variations in medical care and for intervening to improve care.

Cited by 49 publications

References 13 publications

Repeated, Close Physician Coronary Artery Bypass Grafting Teams Associated with Greater Teamwork

Repeated, Close Physician Coronary Artery Bypass Grafting Teams Associated with Greater Teamwork

Association Between Physician Teamwork and Health System Outcomes After Coronary Artery Bypass Grafting

Comparing methods of grouping hospitals

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