Centre for Complex Systems Research, The University of Sydney, Room 402, PNR Building, Sydney, Australia.
Eur J Public Health. 2012 Oct;22(5):629-33. doi: 10.1093/eurpub/ckr153. Epub 2011 Oct 27.
Previous studies have documented the effect of collaboration among physicians on the effectiveness in delivering health services and in producing better patient outcomes. However, there is no systematic empirical study suggesting the underlying relationship between the collaboration network of physicians and its effect on hospitalization cost and readmission rate. In this study, we explore the effect of different attributes (i.e. degree centrality, betweenness centrality, network density and network distance) of physician collaboration network (PCN) on hospitalization cost and readmission rate.
We analyse health insurance claim data set of total hip replacement (THR) patients to construct PCN and to test the effect of its network attributes on hospitalization cost and readmission rate. We consider patient age as moderating factor, which could affect the relation of the PCN attributes with hospitalization cost and readmission rate.
We find that degree centrality (i.e. level of involvement) and network density (i.e. level of connectedness) of PCN are negatively correlated with hospitalization cost and readmission rate. In contrast, betweenness centrality (i.e. capacity to control the flow of information) is found positively correlated with hospitalization cost and readmission rate. Distance (i.e. embeddedness of actors in a network) is found positively correlated with hospitalization cost but negatively correlated with readmission rate. We do not notice any significant impact of patient age on the relation of PCN attributes with hospitalization cost and readmission rate.
The results show that the structure of PCNs is related to indicators of hospital costs and quality (readmission). In their respective hospitals, health-care managers or administrators may follow our research findings to reduce cost and improve quality.
先前的研究记录了医生之间的合作对提供卫生服务的有效性和产生更好的患者结果的影响。然而，没有系统的实证研究表明医生合作网络及其对住院费用和再入院率的影响之间的潜在关系。在这项研究中，我们探讨了医生合作网络（PCN）的不同属性（即度中心性、中间中心性、网络密度和网络距离）对住院费用和再入院率的影响。
我们分析了全髋关节置换（THR）患者的医疗保险索赔数据集，以构建 PCN，并测试其网络属性对住院费用和再入院率的影响。我们将患者年龄视为调节因素，这可能会影响 PCN 属性与住院费用和再入院率的关系。
我们发现 PCN 的度中心性（即参与度水平）和网络密度（即连通度水平）与住院费用和再入院率呈负相关。相比之下，中间中心性（即控制信息流的能力）与住院费用和再入院率呈正相关。距离（即参与者在网络中的嵌入程度）与住院费用呈正相关，但与再入院率呈负相关。我们没有注意到患者年龄对 PCN 属性与住院费用和再入院率关系的任何显著影响。
结果表明，PCN 的结构与医院成本和质量（再入院）的指标有关。在各自的医院中，医疗保健经理或管理人员可以根据我们的研究结果来降低成本和提高质量。
