Virtuelle Behandlernetzwerke

Stillfried, Dominik von; Ermakova, Tatiana; Ng, Frank; Czihal, Thomas

doi:10.1007/s00103-017-2641-7

Cited by 8 publications

(16 citation statements)

References 26 publications

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“…It does so by providing insights on medical specialists in office settings. Furthermore, the article extends the PSN literature, which predominantly relies on studies from Anglo-American countries (Stillfried et al. , 2017), by a perspective on a continental European welfare state.…”

Section: Introductionmentioning

confidence: 94%

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Relational capital in referrer networks of medical specialists in office settings

Pflugfelder

Ng²

2022

JIC

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PurposeThe purpose of this article is to explore the association of the Relational Capital (RC) embedded in a medical specialist’s social–professional network with the specialist’s economic performance based on social network analysis (SNA).Design/methodology/approachUsing health insurance claims data regarding ∼108,000 physicians treating ∼72,000,000 patients, social–professional networks (patient-sharing-networks (PSNs)) of ∼26,000 medical specialists were simulated. To explore the correlation of the network's characteristics (degree centrality, density, relative betweenness centrality and referrer concentration) with economic performance, ordinary-least-squares (OLS)-regression models were estimated for ten common specialties (gynecology, internal medicine, orthopedics, ophthalmology, otolaryngology, dermatology, urology, neurology, radiology and rehabilitative medicine).FindingsThe study confirms the applicability and strong explanatory power of SNA metrics for RC measurement in ambulatory healthcare. Degree centrality and relative betweenness centrality correlate positively with economic performance, whereas density and referrer concentration exhibit negative coefficients. These results confirm the argument that RC has a strong association with the economic performance of medical specialists.Originality/valueThe study pioneers SNA for RC measurement in healthcare. It is among the first publications on specialists' PSNs. Questions for future research are proposed.

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Section: Introductionmentioning

confidence: 94%

“…the number of physician offices a specialist's office is connected to by patient-sharing ties (Barnett et al. , 2012a; Stillfried et al. , 2017).…”

Section: Literature-based Hypothesis Development and Variable Selectionmentioning

confidence: 99%

Relational capital in referrer networks of medical specialists in office settings

Pflugfelder

Ng²

2022

JIC

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“…The methods for constructing these patient-sharing networks vary depending on the aims of the studies in which they are employed. Most studies of this nature have used routine data to identify all pairs of physicians who are connected through the patients they have in common, and to construct complex networks from these pairs [17][18][19][20][21][22][23][24][25]. Landon et al [18] used SNA to identify networks of physicians who would be suitable candidates for building Accountable Care Organizations (ACOs) in the United States because of their shared patient group.…”

Section: Introductionmentioning

confidence: 99%

Using social network analysis methods to identify networks of physicians responsible for the care of specific patient populations

Flemming

Schüttig

et al. 2022

BMC Health Serv Res

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Background Coordinating health care within and among sectors is crucial to improving quality of care and avoiding undesirable negative health outcomes, such as avoidable hospitalizations. Quality circles are one approach to strengthening collaboration among health care providers and improving the continuity of care. However, identifying and including the right health professionals in such meetings is challenging, especially in settings with no predefined patient pathways. Based on the Accountable Care in Germany (ACD) project, our study presents a framework for and investigates the feasibility of applying social network analysis (SNA) to routine data in order to identify networks of ambulatory physicians who can be considered responsible for the care of specific patients. Methods The ACD study objectives predefined the characteristics of the networks. SNA provides a methodology to identify physicians who have patients in common and ensure that they are involved in health care provision. An expert panel consisting of physicians, health services researchers, and data specialists examined the concept of network construction through informed decisions. The procedure was structured by five steps and was applied to routine data from three German states. Results In total, 510 networks of ambulatory physicians met our predefined inclusion criteria. The networks had between 20 and 120 physicians, and 72% included at least ten different medical specialties. Overall, general practitioners accounted for the largest proportion of physicians in the networks (45%), followed by gynecologists (10%), orthopedists, and ophthalmologists (5%). The specialties were distributed similarly across the majority of networks. The number of patients this study allocated to the networks varied between 95 and 45,268 depending on the number and specialization of physicians per network. Conclusions The networks were constructed according to the predefined characteristics following the ACD study objectives, e.g., size of and specialization composition in the networks. This study shows that it is feasible to apply SNA to routine data in order to identify groups of ambulatory physicians who are involved in the treatment of a specific patient population. Whether these doctors are also mainly responsible for care and if their active collaboration can improve the quality of care still needs to be examined.

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“…A look at the literature suggests that a majority of studies into unwarranted practice variation focuses on the global, national, or regional level. Only a few studies explore how it “can be traced back to actions of individual patients and their health care providers” (von Stillfried, Ermakova, & Czihal, 2017, p. 1358). Moreover, methods for analyzing interactions between patients and care providers tend to be limited to quantitative approaches, including standard descriptive statistics and approaches related to graph theory and social-network analysis (Pollack, Weissman, Lemke, Hussey, & Weiner, 2012; von Stillfried et al, 2017).…”

Section: Introductionmentioning

confidence: 99%

“…Only a few studies explore how it “can be traced back to actions of individual patients and their health care providers” (von Stillfried, Ermakova, & Czihal, 2017, p. 1358). Moreover, methods for analyzing interactions between patients and care providers tend to be limited to quantitative approaches, including standard descriptive statistics and approaches related to graph theory and social-network analysis (Pollack, Weissman, Lemke, Hussey, & Weiner, 2012; von Stillfried et al, 2017). Although the benefits of ethnography in health-services research have been acknowledged (e.g., Ong, 1993; Savage, 2000), to the best of my knowledge, no study has thus far used ethnographically inspired methods to explicitly understand sources of practice variation at the level of the physician–patient encounter.…”

Section: Introductionmentioning

confidence: 99%

How to Uncover Sources of Unwarranted Practice Variation: A Case Study in Emergency Medicine

Feufel

2018

Qual Health Res

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Forty years of statistical database analyses have demonstrated the existence of unwarranted practice variation in care delivery, that is, variations independent of medical need, evidence, or patient preference. Alas, little is known about the underlying mechanisms and thus finding interventions to reduce unwarranted variations remains difficult, hampering quality, equity, and efficiency of care. Whereas statistical analyses describe deviations from ideal patterns, ethnographically inspired analyses aim at understanding when, how, and why variations occur in practice. Based on case studies derived from shadowing emergency physicians, I demonstrate that analyzing practice variation in practice helps to (a) advance the understanding of mechanisms and (b) evaluate/expand the existing repertoire of interventions. Results revealed unmet expectations and new sources of known variations as well as interventions complementing systemic changes with those that empower individuals to better cope with the existing system. These findings highlight the benefits of mixed-methods for understanding and tackling practice variation.

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Virtuelle Behandlernetzwerke

Cited by 8 publications

References 26 publications

Relational capital in referrer networks of medical specialists in office settings

Relational capital in referrer networks of medical specialists in office settings

Using social network analysis methods to identify networks of physicians responsible for the care of specific patient populations

How to Uncover Sources of Unwarranted Practice Variation: A Case Study in Emergency Medicine

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