Understanding the implementation of evidence-based care: A structural network approach

Abstract

BackgroundRecent study of complex networks has yielded many new insights into phenomenon such as social networks, the internet, and sexually transmitted infections. The purpose of this analysis is to examine the properties of a network created by the 'co-care' of patients within one region of the Veterans Health Affairs.MethodsData were obtained for all outpatient visits from 1 October 2006 to 30 September 2008 within one large Veterans Integrated Service Network. Types of physician within each clinic were nodes connected by shared patients, with a weighted link representing the number of shared patients between each connected pair. Network metrics calculated included edge weights, node degree, node strength, node coreness, and node betweenness. Log-log plots were used to examine the distribution of these metrics. Sizes of k-core networks were also computed under multiple conditions of node removal.ResultsThere were 4,310,465 encounters by 266,710 shared patients between 722 provider types (nodes) across 41 stations or clinics resulting in 34,390 edges. The number of other nodes to which primary care provider nodes have a connection (172.7) is 42% greater than that of general surgeons and two and one-half times as high as cardiology. The log-log plot of the edge weight distribution appears to be linear in nature, revealing a 'scale-free' characteristic of the network, while the distributions of node degree and node strength are less so. The analysis of the k-core network sizes under increasing removal of primary care nodes shows that about 10 most connected primary care nodes play a critical role in keeping the k-core networks connected, because their removal disintegrates the highest k-core network.ConclusionsDelivery of healthcare in a large healthcare system such as that of the US Department of Veterans Affairs (VA) can be represented as a complex network. This network consists of highly connected provider nodes that serve as 'hubs' within the network, and demonstrates some 'scale-free' properties. By using currently available tools to explore its topology, we can explore how the underlying connectivity of such a system affects the behavior of providers, and perhaps leverage that understanding to improve quality and outcomes of care.

What supports physiotherapists’ use of research in clinical practice? A qualitative study in Sweden

“…Recent research has pointed to the critical importance of to healthcare professionals of social networks for the adoption of new practices in healthcare [78,79]. Parchman et al [80] argued that efforts to understand the research–practice gap have been hindered by a lack of recognition of the social networks within which healthcare professionals are embedded. Networks have increasingly emerged as a strategy by governments to facilitate the transfer of more research into clinical practice in healthcare [66].…”

Multimorbidity in chronic disease: impact on health care resources and costs

“…The field of implementation science has made very good advancements in recent decades and has great potential for further application in the context of interventions and models of care for people with multimorbidity and complex health care requirements. 144 , 145 …”

The Mutation of Professionalism as a Contested Diffusion Process: Clinical Guidelines as Carriers of Institutional Change in Medicine

“…Taking first the horizontal dimension: new ideas tend to spread more widely within group boundaries than across them, and the extent of intra‐organizational diffusion thus depends on ties across units (Granovetter, ). Diffusion will be easier to assure where the organization's formal structure groups people effectively by degree of task interdependence and where it provides the integrative mechanisms needed to coordinate the ensemble of these groupings (Barnsley et al., ; Parchman et al., ; Thompson, ). The vertical dimension is important too: a considerable body of research (reviewed by Cotton et al., ) supports the intuition that the relative advantage, both real and perceived, of an innovation and the willingness to adopt the innovation will be greater when users have more opportunity to participate in the innovation's development, refinement, and implementation.…”