Stat 992: Health Services Research and Network Analysispages.stat.wisc.edu/~karlrohe/netsci/SNASeminar.pdf · 3 Chambers D et al. "Social network analysis in healthcare settings:

Stat 992: Health Services Research and Network Analysis

Eva DuGoff, PhD

Department of Population Health SciencesSchool of Medicine and Public Health

University of Wisconsin-Madison

[email protected]

September 24, 2015

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Overview

1 IntroductionHi, Nice to meet youWhat is Public Health?More on the Medical Care System

2 Network Analysis and Health Services ResearchLiterature ReviewFuture Directions

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Section 1

Introduction

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Subsection 1

Hi, Nice to meet you

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My Background

• Johns Hopkins Bloomberg School of Public Health

• Health Services Research and Policy

• Former Congressional legislative staffer

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My Background




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My Background




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My Background




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Subsection 2

What is Public Health?

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• ”Public health promotes and protects the health of people and thecommunities where they live, learn, work and play.” –American PublicHealth Association

• ”Saving lives, Millions at a time” – JHBSPH

• Public health professionals have worked on housing, seat belts, airbags, food safety, clean water, health insurance, and medical care.

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Public health is about shifting the curve

Source: Whelton and Klag, Drugs, 1986

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Subsection 3

More on the Medical Care System

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Medical Care is an Important Determinant of Health

• In 2013, the US spent $2.9trillion ($9,255 per capita) onhealth care

• Medicare (65+ and seriouslydisabled) accounts for 20% ofnational health spending($585.7 billion in 2013)

• 79% of Medicare spending is onindividuals with 5 or morechronic conditions

Figure : Percentage of MedicareExpenditures, 2007

Source: National Health Expenditure, Centers for Medicare and Medicaid Services, 2014; Anderson G, Chronic Care Chartbook,Robert Wood Johnson Foundation, 2010.

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Section 2

Network Analysis and Health Services Research

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Subsection 1

Literature Review

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Network Analysis in Health Services Research

Source: PubMed on Sept 23, 201513 / 24

Scoping Review

Study objectives:

1 Conduct a systematic search of the published literature for papersusing patient sharing data to examine the health care system;

2 Map out the characteristics and range of methodologies used in theidentified papers;

3 Examine reported conceptualizations, challenges, and limitations ofnetwork measures;

4 Propose recommendations for advancing the application of networkanalysis studies in health services research; and,

5 Develop a conceptual framework to guide measure selection andmethods.

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Scoping Review

Methods

• Extracted titles and abstracts from PubMed and Embase fromdatabase inception to July 2015. We collected titles using termsincluding ”network”, ”patient sharing”, ”connectedness” andvariations thereof

• Identified over 5000 titles and narrowed our search down to 39 fulltext papers.

• Three other reviews of the social network analysis but did not findanother review examining the issue of measurement and patientsharing data.

• Currently in the process of finalizing the data extraction form for thefull text reviews

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Other Systematic Reviews

1 Bae SH et al, ”Health care provider social network analysis: Asystematic review.” 2015

• Although considerable progress has been made in understanding healthcare provider networks, their structure, and their development, littlehas been known about their effectiveness in the health care setting andtheir contributions to quality of care and patient safety.

• Up to 2013• 29 published articles; Current studies on the social ties of health care

workforce professionals include several assessments of inefficiencies.The level of technical sophistication in these studies tended to be low.Future study using enhanced sophistication in study design, analysis,and patient outcome testing are warranted to fully leverage thepotential of SNA in health care studies.

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2 Cunningham FC et al. ”Health professional networks as a vector forimproving healthcare quality and safety: a systematic review.” 2012

• To conduct a systematic review of studies of professionals’ networkstructures, identifying factors associated with network effectiveness andsustainability, particularly in relation to quality of care and patientsafety.

• January 1995 to December 2009• A majority of the 26 unique studies identified used social network

analysis to examine structural relationships in networks: structuralrelationships within and between networks, health professionals andtheir social context, health collaboratives and partnerships, andknowledge sharing networks. Key aspects of networks explored wereadministrative and clinical exchanges, network performance,integration, stability and influences on the quality of healthcare. Morerecent studies show that cohesive and collaborative health professionalnetworks can facilitate the coordination of care and contribute toimproving quality and safety of care. Structural network vulnerabilitiesinclude cliques, professional and gender homophily, and over-reliance oncentral agencies or individuals.

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3 Chambers D et al. ”Social network analysis in healthcare settings: asystematic scoping review.” 2012

• Aim to use SNA to inform the development and implementation oftailored behavior-change interventions to improve the uptake ofevidence into practice in the English National Health Service.

• Up to October 2010• We included 52 completed studies, reported in 62 publications. Almost

all of the studies were limited to cross sectional descriptions ofnetworks; only one involved using the results of the SNA as part of anintervention to change practice.

• Found very little evidence for the potential of SNA being realised inhealthcare settings. However, it seems unlikely that networks are lessimportant in healthcare than other settings. Future research shouldseek to go beyond the merely descriptive to implement and evaluateSNA-based interventions.

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Scoping Review - (A few) Preliminary Results

Type Measure Author/Year

Provider-Centric

Degree Ong 2015, Pollack 2015, Casalino 2014Jaccard similarity Ong 2015Betweeness centrality Casalino 2014Clustering Hollingsworth 2015Repeat-tie Fraction Hollingsworth 2015No of External Ties Hollingsworth 2015Personal network density Mandl 2014Personal network size Mandl 2014

Patient-CentricCare Density Pollack 2013, Ong 2015Constellation composition Mandl 2014Constellation density Mandl 2014

Table : Exemplar Measures

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Ong 2015

• Objective: To elucidate theeffect of providerprofessional relationships onmultiple-provider prescribingof benzodiazepines, usingsocial network analytics.

• Finding: Provider pairs whoshared a greater number ofpatients and collaboratorswere less likely toco-prescribebenzodiazepines.

Mandl 2014

• Objective: To indirectlymeasure teamwork andprovider collaboration, wemeasure recurrence ofprovider constellations andcohesion among providers.

• Finding: Cohesion amongproviders is not the norm.Instead, the often ad hocconstellations of providerscaring for patients are notpersistent teams.

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Pollack 2015

• Objective: To examine ifphysician peer exposure wasassociated with thesubsequent adoption of anew approach(brachytherapy) to treat ofwomen with early-stagebreast cancer.

• Finding: Exposure to peerswho were early adopters ofbrachytherapy was found tobe associated with asurgeon’s subsequent uptakeof brachytherapy

Hollingsworth 2015

• Objective: To explorephysician isolation incommunities with highproportions of blackresidents as a factorcontributing to racialdisparities in access tohigh-quality hospitals forcardiac surgery.

• Finding: Physicians in areaswith many black residentsare more isolated; thisisolation may negativelyimpact on care coordinationand information sharing.

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Subsection 2

Future Directions

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Future Directions

• What’s the relationship between hospital physician networkcharacteristics and patient health outcomes?

• Map the network relationships among hospitals treating patients foremergency general surgery and examine whether patients aretransferred to better performing hospitals.

• Do current health care provider communities correspond to thestandard measures in the field?

• How have recent policy changes around vertical integration ofhospitals and physicians affected physician network cohesion?

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Thank You!

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Documents

Stat 992: Health Services Research and Network Analysispages.stat.wisc.edu/~karlrohe/netsci/SNASeminar.pdf · 3 Chambers D et al. "Social network analysis in healthcare settings: