Geva Alon, Olson Karen L, Liu Chunfu, Mandl Kenneth D
1 Boston Children's Hospital, Boston, MA, USA.
2 Harvard Medical School, Boston, MA, USA.
Med Care Res Rev. 2019 Feb;76(1):115-128. doi: 10.1177/1077558717718626. Epub 2017 Jul 8.
Provider interactions other than explicit care coordination, which is challenging to measure, may influence practice and outcomes. We performed a network analysis using claims data from a commercial payor. Networks were identified based on provider pairs billing outpatient care for the same patient. We compared network variables among patients who had and did not have a 30-day readmission after hospitalization for heart failure. After adjusting for comorbidities, high median provider connectedness-normalized degree, which for each provider is the number of connections to other providers normalized to the number of providers in the region-was the network variable associated with reduced odds of readmission after heart failure hospitalization (odds ratio = 0.55; 95% confidence interval [0.35, 0.86]). We conclude that heart failure patients with high provider connectedness are less likely to require readmission. The structure and importance of provider relationships using claims data merits further study.
除了明确的护理协调（这很难衡量）之外，医疗服务提供者之间的互动可能会影响医疗实践和结果。我们使用来自商业医保支付方的理赔数据进行了网络分析。网络是根据为同一名患者提供门诊护理计费的医疗服务提供者对来确定的。我们比较了心力衰竭住院后有和没有30天再入院情况的患者之间的网络变量。在对合并症进行调整后，较高的中位医疗服务提供者连通性标准化度数（对于每个医疗服务提供者而言，这是与其他医疗服务提供者的连接数除以该地区医疗服务提供者的数量）是与心力衰竭住院后再入院几率降低相关的网络变量（比值比 = 0.55；95%置信区间[0.35, 0.86]）。我们得出结论，医疗服务提供者连通性高的心力衰竭患者再次入院的可能性较小。利用理赔数据研究医疗服务提供者关系的结构和重要性值得进一步研究。
