Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
J Gen Intern Med. 2019 Oct;34(10):2014-2020. doi: 10.1007/s11606-019-04978-9. Epub 2019 Apr 3.
Measuring care coordination in administrative data facilitates important research to improve care quality.
To compare shared patient networks constructed from administrative claims data across multiple payers.
Social network analysis of pooled cross sections of physicians treating prevalent colorectal cancer patients between 2003 and 2013.
Surgeons, medical oncologists, and radiation oncologists identified from North Carolina Central Cancer Registry data linked to Medicare claims (N = 1735) and private insurance claims (N = 1321).
Provider-level measures included the number of patients treated, the number of providers with whom they share patients (by specialty), the extent of patient sharing with each specialty, and network centrality. Network-level measures included the number of providers and shared patients, the density of shared-patient relationships among providers, and the size and composition of clusters of providers with a high level of patient sharing.
For 24.5% of providers, total patient volume rank differed by at least one quintile group between payers. Medicare claims missed 14.6% of all shared patient relationships between providers, but captured a greater number of patient-sharing relationships per provider compared with the private insurance database, even after controlling for the total number of patients (27.242 vs 26.044, p < 0.001). Providers in the private network shared a higher fraction of patients with other providers (0.226 vs 0.127, p < 0.001) compared to the Medicare network. Clustering coefficients for providers, weighted betweenness, and eigenvector centrality varied greatly across payers. Network differences led to some clusters of providers that existed in the combined network not being detected in Medicare alone.
Many features of shared patient networks constructed from a single-payer database differed from similar networks constructed from other payers' data. Depending on a study's goals, shortcomings of single-payer networks should be considered when using claims data to draw conclusions about provider behavior.
在管理数据中测量护理协调情况有助于进行提高护理质量的重要研究。
比较来自多个付款人的行政索赔数据中构建的共享患者网络。
对 2003 年至 2013 年间患有常见结直肠癌的患者进行的医生的交叉部分的社会网络分析。
从北卡罗来纳中央癌症登记处的数据中确定外科医生、肿瘤内科医生和放射肿瘤学家，这些数据与医疗保险索赔（N=1735）和私人保险索赔（N=1321）相关联。
提供者水平的措施包括治疗的患者数量、与他们共享患者的提供者数量（按专业）、与每个专业的患者共享程度以及网络中心性。网络水平的措施包括提供者和共享患者的数量、提供者之间共享患者关系的密度以及具有高患者共享水平的提供者集群的大小和组成。
对于 24.5%的提供者，在不同的付款人之间，总患者量排名至少相差一个五分位组。医疗保险索赔错过了提供者之间所有共享患者关系的 14.6%，但与私人保险数据库相比，每提供者捕获的患者共享关系数量更多，即使在控制了患者总数之后（27.242 与 26.044，p<0.001）。与医疗保险网络相比，私人网络中的提供者与其他提供者共享了更高比例的患者（0.226 与 0.127，p<0.001）。提供者的聚类系数、加权中间度和特征向量中心性在付款人之间差异很大。网络差异导致在联合网络中存在的一些提供者集群在医疗保险网络中未被检测到。
从单一付款人数据库构建的共享患者网络的许多特征与从其他付款人数据构建的类似网络不同。根据研究的目的，在使用索赔数据得出关于提供者行为的结论时，应考虑单一付款人网络的缺点。
