Medical Inter-Specialty Referral Networks
Authors: 
Tatiana Ermakova, Benjamin Fabian, Michael Erhart, Thomas Czihal, Dominik von StillfriedAuthors Info & Claims
Pages 62 - 67
Abstract
Motivated by their increasing popularity and usefulness in the English-speaking world, we model and analyze patient referral networks for medical specialties based on Germany-wide claims data from the fourth quarter of 2015. Based on the average values of local graph measures, different groups of medical specialties could be distinguished. Family physicians have almost perfect average out-degree and closeness centrality. Based on the principal components applied to local graph measures, four clusters of local medical specialties could be identified, that are characteristic for (1) orthopedists, surgeons, otolaryngologists, dermatologists and internists; (2) non-medical psychotherapists, pediatricians, gynecologists, and ophthalmologists; (3) only family physicians in Bremen and internists in Hamburg and Saarland; (4) the remaining family physicians. This study can serve as a basis for further network simulations and monitoring to achieve the desired health care outcomes, optimal resource allocation and protection against infections.
References
[1]
“Statistisches Bundesamt,” 2015. [Online]. Available: www.destatis.de.
[2]
F. C. Cunningham, G. Ranmuthugala, J. Plumb, A. Georgiou, J. I. Westbrook, and J. Braithwaite, “Health professional networks as a vector for improving healthcare quality and safety: a systematic review,” BMJ Qual. Saf., vol. 21, no. 3, pp. 239–249, 2011.
[3]
A. Donabedian, “The Quality of Care: How Can It Be Assessed?,” JAMA J. Am. Med. Assoc., vol. 260, no. 12, pp. 1743–1748, 1988.
[4]
M. L. Barnett, B. E. Landon, A. J. O. Malley, N. L. Keating, and N. A. Christakis, “Mapping Physician Networks with Self-Reported and Administrative Data,” Health Serv. Res., vol. 46, no. May 2004, pp. 1–18, 2011.
[5]
T. Hussain, H.-Y. Chang, C. M. Veenstra, and C. E. Pollack, “Collaboration Between Surgeons and Medical Oncologists and Outcomes for Patients With Stage III Colon Cancer,” J. Oncol. Pract., vol. 11, no. 3, pp. e388–e397, 2015.
[6]
C. E. Pollack, G. E. Weissman, K. W. Lemke, P. S. Hussey, and J. P. Weiner, “Patient Sharing among Physicians and Costs of Care: A Network Analytic Approach to Care Coordination Using Claims Data,” J Gen Intern Med, vol. 28, pp. 459–465, 2013.
[7]
M. S. Ong, K. L. Olson, A. Cami, C. Liu, F. Tian, N. Selvam, and K. D. Mandl, “Provider Patient-Sharing Networks and Multiple-Provider Prescribing of Benzodiazepines,” J. Gen. Intern. Med., 2016.
[8]
M. S. Ong, K. L. Olson, L. Chadwick, C. Liu, and K. D. Mandl, “The Impact of Provider Networks on the Co-Prescriptions of Interacting Drugs: A Claims-Based Analysis,” Drug Saf., 2017.
[9]
M. B. Carson, D. M. Scholtens, C. N. Frailey, S. J. Gravenor, G. E. Kricke, and N. D. Soulakis, “An outcome-weighted network model for characterizing collaboration,” PLoS One, vol. 11, no. 10, p. e0163861, 2016.
[10]
M. B. Carson, “Characterizing Teamwork in Cardiovascular Care Outcomes,” Circ. Cardiovasc. Qual. Outcomes, vol. 9, no. 6, pp. 670 LP – 678, 2016.
[11]
H. H. Altalib, “Care coordination in epilepsy: Measuring neurologists’ connectivity using social network analysis,” Epilepsy Behav., vol. 73, pp. 31–35, 2017.
[12]
E. L. Moen, A. M. Austin, J. P. Bynum, J. S. Skinner, and A. J. O'Malley, “An analysis of patient-sharing physician networks and implantable cardioverter defibrillator therapy,” Heal. Serv. Outcomes Res. Methodol., 2016.
[13]
B. E. Landon, “Variation in Patient-Sharing Networks of Physicians across the United States,” JAMA J. Am. Med. Assoc., vol. 308, no. 3, pp. 265–73, 2012.
[14]
B. E. Landon, “Using Administrative Data to Identify Naturally Occurring Networks of Physicians,” Med. Care, vol. 51, no. 8, pp. 715–721, 2013.
[15]
T. A. Stukel, “Multispecialty physician networks in Ontario,” Open Med., 2013.
[16]
B. Y. Lee, “Long-Term Care Facilities: Important Participants of the Acute Care Facility Social Network?,” PLoS One, 2011.
[17]
B. Y. Lee, “Social Network Analysis of Patient Sharing Among Hospitals in Orange County, California,” Am. J. Public Health, 2011.
[18]
M. Wensing, M. van der Eijk, J. Koetsenruijter, B. R. Bloem, M. Munneke, and M. Faber, “Connectedness of Healthcare Professionals Involved in the Treatment of Patients with Parkinson's Disease: A Social Networks Study,” Implement. Sci., vol. 6, no. 1, p. 67, 2011.
[19]
H. H. Pham, A. S. O'Malley, P. B. Bach, C. Saiontz-Martinez, and D. Schrag, “Primary Care Physicians’ Links to Other Physicians through Medicare Patients: The Scope of Care Coordination,” Ann Intern Med, vol. 150, pp. 236–242, 2009.
[20]
A. Gundlapalli, “Social network analyses of patient-healthcare worker interactions: implications for disease transmission,” in AMIA Annu Symp Proc, 2009, vol. 2009, pp. 213–217.
[21]
T. J. Iwashyna, J. D. Christie, J. Moody, J. M. Kahn, and D. A. Asch, “The structure of critical care transfer networks,” Med. Care, vol. 47, no. 7, pp. 787–793, 2009.
[22]
S. Uddin, L. Hossain, and M. Kelaher, “Effect of Physician Collaboration Network on Hospitalization Cost and Readmission Rate,” Eur J Public Heal., vol. 22, no. 5, pp. 629–33, 2012.
[23]
S. Uddin, M. Kelaher, and M. Piraveenan, “Impact of Physician Community Structure on Healthcare Outcomes,” Stud. Health Technol. Inform., vol. 2015, no. 214, pp. 152–8, 2015.
[24]
M. Uddin, M. Kelaher, and U. Srinivasan, “A framework for administrative claim data to explore healthcare coordination and collaboration,” Aust. Heal. Rev., vol. 40, no. 5, pp. 500–510, 2016.
[25]
S. Uddin, “Exploring the Impact of Different Multi-Level Measures of Physician Communities in Patient-Centric Care Networks on Healthcare Outcomes: A Multi-Level Regression Approach,” Sci. Rep., vol. 6, pp. 1–10, 2016.
[26]
P. M. Polgreen and A. M. Segre, “Editorial Commentary: Network Models, Patient Transfers, and Infection Control,” Clin Infect Dis, vol. 63, no. 7, pp. 894–5, 2016.
[27]
M. J. Ray, M. Y. Lin, and W. E. Trick, “Predicting Facility-Level Carbapenem-Resistant Enterobacteriaceae (CRE) Incidence Based on Social Network Measures,” Online J. Public Health Inform., vol. 8, no. 1, 2016.
[28]
M. J. Ray, M. Y. Lin, R. A. Weinstein, and W. E. Trick, “Spread of Carbapenem-Resistant Enterobacteriaceae among Illinois Healthcare Facilities: The Role of Patient Sharing,” Clin. Infect. Dis., 2016.
[29]
J. E. Simmering, L. A. Polgreen, D. R. Campbell, J. E. Cavanaugh, and P. M. Polgreen, “Hospital Transfer Network Structure as a Risk Factor for Clostridium difficile Infection,” Infect Control Hosp Epidemiol, vol. 36, no. 9, pp. 1031–7, 2015.
[30]
A. Lomi, D. Mascia, D. Q. Vu, F. Pallotti, G. Conaldi, and T. J. Iwashyna, “Do Patient Sharing Networks between Hospitals Afford Access to Better Care?,” Med Care, vol. 52, no. 5, pp. 407–14, 2014.
[31]
C. E. Pollack, “It's who you know: Patient-sharing, quality, and costs of cancer survivorship care,” J. Cancer Surviv., 2014.
[32]
C. E. Pollack, K. W. Lemke, E. Roberts, and J. P. Weiner, “Patient Sharing and Quality of Care: Measuring Outcomes of Care Coordination Using Claims Data,” Med Care, vol. 53, no. 4, pp. 317–23, 2015.
[33]
M. L. Barnett, N. A. Christakis, J. O'Malley, J. P. Onnela, N. L. Keating, and B. E. Landon, “Physician Patient-Sharing Networks and the Cost and Intensity of Care in US Hospitals,” Med Care, vol. 50, no. 2, pp. 152–60, 2012.
[34]
M. Klora, J. Zeidler, M. May, N. Raabe, and J. M. G. von der Schulenburg, “Evaluation der hausarztzentrierten Versorgung in Deutschland anhand von GKV-Routinedaten der AOK Rheinland/Hamburg,” Z. Evid. Fortbild. Qual. Gesundhwes., vol. 120, no. 2017, pp. 21–30, 2017.
[35]
D. Stillfried and T. Czihal, “Welchen Beitrag liefern funktional definierte Populationen zur Erklärung regionaler Unterschiede in der medizinischen Versorgung?,” Bundesgesundheitsblatt Gesundheitsforsch. Gesundheitsschutz, vol. 57, pp. 197–206, 2014.
[36]
IQWiG, “Health care in Germany: The German health care system,” Inf. Heal. Online, 2018.
[37]
L. J. Meijer, E. De Groot, M. Blaauw-Westerlaken, and R. A. M. J. Damoiseaux, “Intraprofessional collaboration and learning between specialists and general practitioners during postgraduate training: a qualitative study,” BMC Health Serv. Res., 2016.
[38]
A. Caimo, F. Pallotti, and A. Lomi, “Bayesian exponential random graph modelling of interhospital patient referral networks,” Stat. Med., vol. 36, no. 4, 2017.
[39]
D. Stillfried, T. Czihal, and M. Erhart, “Rolle der Krankenhäuser in Deutschland: Daten belegen massiven Reformbedarf,” Zi-Paper, vol. 11, no. 2017, 2017.
[40]
K. Obermann, P. Müller, H.-H. Müller, B. Schmidt, and B. Glazinski, The German Health Care System A Concise Overview. 2013.
[41]
E. H. DuGoff, S. Fernandes-Taylor, G. E. Weissman, J. H. Huntley, and C. E. Pollack, “A scoping review of patient-sharing network studies using administrative data,” Transl. Behav. Med., vol. 8, no. 4, pp. 598–625, Jul. 2018.
[42]
B. Liu, Web Data Mining: Exploring Hyperlinks, Contents, and Usage Data. 2011.
[43]
M. J. Zaki and J. Wagner Meira, Data Mining and Analysis: Fundamental Concepts and Algorithms. Cambridge University Press, 2014.
[44]
M. E. J. Newman, “Mixing Patterns in Networks,” Phys. Rev. E, 67 026126, 2003.
[45]
D. Romero, “Applied Social Network Analysis in Python.” 2017.
[46]
A.-L. Barabási, Network Science. 2016.
[47]
M. Tsvetovat and A. Kouznetsov, Social Network Analysis for Startups. O'Reilly Media, 2011.
[48]
C. Ding and X. He, “K -means clustering via principal component analysis,” in Twenty-first international conference on Machine learning - ICML ’04, 2004, p. 29.
[49]
U. Srinivasan and S. Uddin, “A Social Network Framework to Explore Healthcare Collaboration,” arXiv, 2015.
[50]
L. C. Freeman, “Centrality in networks: I. Conceptual clarification,” Soc. Networks, vol. 1, pp. 215–239, 1979.
[51]
A. N. Langville and C. D. Meyer, “A Survey of Eigenvector Methods for Web Information Retrieval,” SIAM Rev., vol. 47, no. 1, pp. 135–161, 2005.
Recommendations
Issues and opportunities in transitions from speciality care: a field study of bone marrow transplant
Medical teamwork, collaboration and patient-centred careTransitional points in patient care, such as handoffs and hospital discharges, are known to have unique information challenges. Transitions following long-term care involve even more complex processes. In this study, we examine the informational and ...
MedSpecSearch: Medical Specialty Search
Advances in Information RetrievalAbstractMedSpecSearch () is a search engine for helping users to find the relevant medical specialty for a doctor visit based on users’ description of symptoms. This system is useful for users who are not sure of which medical ...
Find Referral Social Networks
SOCIALSEC '15: Proceedings of the 2015 International Symposium on Security and Privacy in Social Networks and Big Data (SocialSec)With the generalizing of Electronic Medical Records lots of facilities such as hospitals, insurance companies and some other government sections, accumulate large amounts of electronic data. Generally, data analysis technologies used in health insurance ...
Comments
Please enable JavaScript to view thecomments powered by Disqus.Information & Contributors
Information
Published In
December 2021
541 pages
Copyright © 2021 ACM.
Permission to make digital or hard copies of all or part of this work for personal or classroom use is granted without fee provided that copies are not made or distributed for profit or commercial advantage and that copies bear this notice and the full citation on the first page. Copyrights for components of this work owned by others than the author(s) must be honored. Abstracting with credit is permitted. To copy otherwise, or republish, to post on servers or to redistribute to lists, requires prior specific permission and/or a fee. Request permissions from [email protected].
Sponsors
Publisher
Association for Computing Machinery
New York, NY, United States
Publication History
Published: 11 April 2022
Check for updates
Author Tags
Qualifiers
- Research-article
- Research
- Refereed limited
Conference
WI-IAT '21
Sponsor:
WI-IAT '21: IEEE/WIC/ACM International Conference on Web Intelligence
December 14 - 17, 2021
VIC, Melbourne, Australia
Contributors
Other Metrics
Bibliometrics & Citations
Bibliometrics
Article Metrics
- 0Total Citations
- 190Total Downloads
- Downloads (Last 12 months)106
- Downloads (Last 6 weeks)14
Reflects downloads up to 24 Nov 2024
Other Metrics
Citations
View Options
View options
View or Download as a PDF file.
PDFeReader
View online with eReader.
eReaderHTML Format
View this article in HTML Format.
HTML FormatLogin options
Check if you have access through your login credentials or your institution to get full access on this article.
Sign in