Variation in Provider Connectedness Associates With Outcomes of Inflammatory Bowel Diseases in an Analysis of Data From a National Health System

Cohen‐Mekelburg, Shirley; Yu, Xianshi; Costa, Deena Kelly; Hofer, Timothy P.; Krein, Sarah L.; Hollingsworth, John M.; Wiitala, Wyndy L.; Saini, Sameer D.; Zhu, Ji; Waljee, Akbar K.

doi:10.1016/j.cgh.2020.08.028

Cited by 7 publications

(5 citation statements)

References 23 publications

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“…Gastroenterologists were more likely to be highly connected than primary care providers, with a higher mean degree centrality (gastroenterologist 23. 19…”

Section: Resultsmentioning

confidence: 99%

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Understanding clinician connections to inform efforts to promote high-quality inflammatory bowel disease care

Cohen‐Mekelburg

Van

et al. 2022

PLoS ONE

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Background Highly connected individuals disseminate information effectively within their social network. To apply this concept to inflammatory bowel disease (IBD) care and lay the foundation for network interventions to disseminate high-quality treatment, we assessed the need for improving the IBD practices of highly connected clinicians. We aimed to examine whether highly connected clinicians who treat IBD patients were more likely to provide high-quality treatment than less connected clinicians. Methods We used network analysis to examine connections among clinicians who shared patients with IBD in the Veterans Health Administration between 2015–2018. We created a network comprised of clinicians connected by shared patients. We quantified clinician connections using degree centrality (number of clinicians with whom a clinician shares patients), closeness centrality (reach via shared contacts to other clinicians), and betweenness centrality (degree to which a clinician connects clinicians not otherwise connected). Using weighted linear regression, we examined associations between each measure of connection and two IBD quality indicators: low prolonged steroids use, and high steroid-sparing therapy use. Results We identified 62,971 patients with IBD and linked them to 1,655 gastroenterologists and 7,852 primary care providers. Clinicians with more connections (degree) were more likely to exhibit high-quality treatment (less prolonged steroids beta -0.0268, 95%CI -0.0427, -0.0110, more steroid-sparing therapy beta 0.0967, 95%CI 0.0128, 0.1805). Clinicians who connect otherwise unconnected clinicians (betweenness) displayed more prolonged steroids use (beta 0.0003, 95%CI 0.0001, 0.0006). The presence of variation is more relevant than its magnitude. Conclusions Clinicians with a high number of connections provided more high-quality IBD treatments than less connected clinicians, and may be well-positioned for interventions to disseminate high-quality IBD care. However, clinicians who connect clinicians who are otherwise unconnected are more likely to display low-quality IBD treatment. Efforts to improve their quality are needed prior to leveraging their position to disseminate high-quality care.

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“…Gastroenterologists were more likely to be highly connected than primary care providers, with a higher mean degree centrality (gastroenterologist 23. 19…”

Section: Resultsmentioning

confidence: 99%

“…Clinicians who cared for patients with IBD during the study period were linked based on previously described methodology, and a patient-sharing network was created [ 19 ]. A network is constructed from nodes representing unique clinicians, and edges or connections, which are represented by the patients that two clinicians share.…”

Section: Methodsmentioning

confidence: 99%

Understanding clinician connections to inform efforts to promote high-quality inflammatory bowel disease care

Cohen‐Mekelburg

Van

et al. 2022

PLoS ONE

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“…Other investigators with a more global view of fragmentation have used network analysis methods to examine the association between interprovider connectedness and the risk of IBD flares or need for surgery, observing that higher connectedness is generally correlated with better outcomes. 22 While this approach has generated valuable insight, it can be difficult to interpret clinically: it remains unclear which interprovider connections are most relevant for patient outcomes and whether the timing of these encounters matters. The same holds true for analyses of large administrative datasets using other global measures of fragmentation, such as the Bice–Boxerman continuity of care index.…”

Section: Discussionmentioning

confidence: 99%

Far From Home: The Role of Travel Distance and Care Fragmentation in Surgical Outcomes for Inflammatory Bowel Disease

Booth

Colorado

Magwood

et al. 2023

Crohn's &Amp; Colitis 360

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Background Fragmented care for inflammatory bowel disease is known to correlate negatively with outcomes, but it is unclear which aspects of care fragmentation are relevant and potentially modifiable. Furthermore, there is little data on the relationship between travel distance and the benefits of integrated care models. Hypothesizing care coordination in the preoperative period may have a significant impact on surgical outcomes, we explored associations between integrated care, travel distance, and surgical outcomes. Methods A single-center retrospective cohort study of patients undergoing index abdominal surgery was done to compare the rate of surgical complications with and without long travel distance and non-integrated preoperative care. Multivariable logistic regression was used to identify factors independently associated with complications. Results 157 patients were included. Complications were more common among patients with travel distance >75 miles (47.6% vs 27.4%, p=0.012). Integrated preoperative care was not significant on bivariate (p=0.381) or multivariable analysis but had a stronger association among patients with travel distance <75 miles (20.9% integrated vs 36.7%, p=0.138). After adjustment, new ileostomy, open surgical approach, and distance >75 miles were independently associated with complications. Conclusions Patients with longer travel distances to the hospital were twice as likely to have a surgical complication after adjusting for other risk factors. Without significant accommodations for remote patients, potential benefits of an integrated model for IBD care may be limited to patients who live close to the medical center. Future efforts addressing continuity of care should consider tactics to mitigate the impact of travel distance on outcomes.

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“…In this study, we demonstrate that adolescents with IBD have decreasing rates of HME compared to their peers as time passes from the diagnosis of IBD. Studies of adult IBD demonstrate that higher provider connectedness (between the gastroenterologist and PCP) and continuity of care are associated with better IBD outcomes (11,12). Although it has previously been shown in a small study by Sainato et al (3) that children with chronic medical conditions have less follow-up with their PCP than healthy controls, that study included only 15 children with gastrointestinal disease.…”

Section: Discussionmentioning

confidence: 99%

Adolescents With Inflammatory Bowel Disease Have Decreased Rates of Health Maintenance Visits

Moran

Aryee

Perrin

2021

J. pediatr. gastroenterol. nutr.

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Variation in Provider Connectedness Associates With Outcomes of Inflammatory Bowel Diseases in an Analysis of Data From a National Health System

Cited by 7 publications

References 23 publications

Understanding clinician connections to inform efforts to promote high-quality inflammatory bowel disease care

Understanding clinician connections to inform efforts to promote high-quality inflammatory bowel disease care

Far From Home: The Role of Travel Distance and Care Fragmentation in Surgical Outcomes for Inflammatory Bowel Disease

Adolescents With Inflammatory Bowel Disease Have Decreased Rates of Health Maintenance Visits

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