John A. Burns School of Medicine, University of Hawaii, 651 Ilalo St, Honolulu, HI 96813. Email:
Am J Manag Care. 2019 Jul 1;25(7):e192-e197.
To illustrate methods using administrative data on patients with diabetes that can offer a foundation for using network analyses in managed care.
The study used an administrative claims database to analyze patients with diabetes in a large health plan in Hawaii in 2010.
The networks were explored graphically and analyzed at several levels of complexity. Levels ranged from major components comprising the majority in the networks to smaller, highly connected cliques to communities of patients and physicians grouped by a network algorithm. The attributes of patients linked by seeing the same primary physicians were evaluated using an exponential random graph model that predicted links in the network.
The study included 41,941 patients with diabetes of Native Hawaiian (16.3%), Filipino (14.2%), Japanese (46.7%), white (11.2%), and other (11.6%) ethnicity. About half were 65 years or older. When examined by Hawaiian island of residence, at least 95% of patients and at least 78% of physicians belonged to loosely connected major components within a network. Smaller communities of patients, identified by being closely linked together, averaged 150 to 177 patients; communities of physicians averaged 3 to 8 physicians. The average numbers of patients sharing physicians and physicians sharing patients were greater on the island of Oahu than on the rural neighboring islands. Patients of the same ethnicity were significantly more likely to share the same primary physician.
Network analyses reveal structures and links that health plans could leverage to strengthen quality improvement and disease management programs.
展示使用糖尿病患者管理数据的方法，为在管理式医疗中使用网络分析奠定基础。
本研究使用一个管理式医疗保险数据库，对 2010 年夏威夷一家大型健康计划中患有糖尿病的患者进行分析。
通过图形方式探索网络，并在几个复杂程度的层次上进行分析。层次范围从构成网络大部分的主要组成部分到较小的、高度连接的小团体，再到按网络算法分组的患者和医生社区。使用预测网络中链接的指数随机图模型评估通过同一主要医生就诊的患者之间的联系属性。
本研究纳入了 41941 名具有夏威夷原住民（16.3%）、菲律宾裔（14.2%）、日本裔（46.7%）、白种人（11.2%）和其他族裔（11.6%）的糖尿病患者。约有一半患者年龄在 65 岁或以上。按居住的夏威夷岛进行检查时，网络中至少有 95%的患者和至少 78%的医生属于松散连接的主要组成部分。通过紧密连接识别的较小的患者社区平均有 150 到 177 名患者；医生社区平均有 3 到 8 名医生。与农村邻岛相比，瓦胡岛的患者共享医生和医生共享患者的平均人数更多。具有相同族裔的患者共享同一主要医生的可能性显著更高。
网络分析揭示了健康计划可以利用的结构和联系，以加强质量改进和疾病管理计划。
