Division of Gastroenterology & Hepatology, University of Michigan, Ann Arbor, Michigan; VA Center for Clinical Management Research, Ann Arbor, Michigan; Institute of Health Policy and Innovation, University of Michigan, Ann Arbor, Michigan.
Department of Statistics, University of Michigan, Ann Arbor, Michigan.
Clin Gastroenterol Hepatol. 2021 Nov;19(11):2302-2311.e1. doi: 10.1016/j.cgh.2020.08.028. Epub 2020 Aug 13.
BACKGROUND & AIMS: Inflammatory bowel diseases (IBD) often require multidisciplinary care with tight coordination among providers. Provider connectedness, a measure of the relationship among providers, is an important aspect of care coordination that has been linked to higher quality care. We aimed to assess variation in provider connectedness among medical centers, and to understand the association between this established measure of care coordination and outcomes of patients with IBD.
We conducted a national cohort study of 32,949 IBD patients with IBD from 2005 to 2014. We used network analysis to examine provider connectedness, defined using network properties that measure the strength of the collaborative relationship, team cohesiveness, and between-facility collaborations. We used multilevel modeling to examine variations in provider connectedness and association with patient outcomes.
There was wide variation in provider connectedness among facilities in complexity, rural designation, and volume of patients with IBD. In a multivariable model, patients followed in a facility with team cohesiveness (odds ratio, 0.38; 95% CI, 0.16-0.88) and where providers often collaborated with providers outside their facility (odds ratio, 0.48; 95% CI, 0.31-0.75) were less likely to have clinically active disease, defined by a composite of outpatient flare, inpatient flare, and IBD-related surgery.
A national study found evidence for heterogeneity in patient-sharing among IBD care teams. Patients with IBD seen at health centers with higher provider connectedness appear to have better outcomes. Understanding provider connectedness is a step toward designing network-based interventions to improve coordination and quality of care.
炎症性肠病（IBD）常需要多学科的医疗服务，提供者之间需要紧密协调。提供者关联度是医疗服务协调的一个重要方面，它衡量的是提供者之间的关系，与更高质量的医疗服务相关。我们旨在评估医疗中心之间提供者关联度的差异，并了解这一既定的医疗服务协调措施与 IBD 患者结局之间的关系。
我们进行了一项全国性队列研究，纳入了 2005 年至 2014 年间的 32949 例 IBD 患者。我们使用网络分析来评估提供者关联度，其定义使用了衡量合作关系强度、团队凝聚力和机构间合作的网络属性。我们使用多水平模型来评估提供者关联度的差异及其与患者结局的关联。
在复杂性、农村指定和 IBD 患者数量方面，医疗机构之间的提供者关联度存在广泛差异。在多变量模型中，在团队凝聚力较高（比值比，0.38；95%CI，0.16-0.88）和提供者经常与机构外的提供者合作（比值比，0.48；95%CI，0.31-0.75）的机构中接受治疗的患者不太可能患有临床活动疾病，该疾病通过门诊发作、住院发作和 IBD 相关手术的综合指标来定义。
一项全国性研究发现了 IBD 护理团队之间患者共享的异质性证据。在关联度较高的医疗机构接受治疗的 IBD 患者的结局似乎更好。了解提供者关联度是朝着设计基于网络的干预措施以改善协调和医疗服务质量迈出的一步。
