Quality of Care and Network Properties of Outpatient Health Care Delivery

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PIs: Caterina Scoglio (ECE), Michael L. Parchman, (University of Texas Health Science Center-San Antonio); student: Phillip Schumm (ECE).


Abstract

Although the health care system has been slow to adopt new evidence, there has been little or no work describing the topology of the complex network of patient care within health care systems. The Veterans Health Administration (VA), the largest integrated health care delivery system in the US, provides an ideal setting to do so. The purpose of this study is to establish the feasibility of examining the topology of networks of health care using VA data and to create a collaborative research agenda between an experienced health services researcher within the VA (Parchman) and a computational engineer with expertise in complex network analysis (Scoglio). Objectives: 1) evaluate adequacy of the data for network analyses; 2) calculate network metrics for 30 VA outpatient clinics; 3) examine relationships between network metrics and the quality of care; and 4) submit a research proposal to the VA Research Office for a national network analysis. Methods: Data from outpatient visits over a 3 year period within a regional Veterans Integrated Service Network (VISN) will be used. Each visit has a unique identifier for the provider seen. Properties of two different networks will be examined. The first will identify physicians as nodes and patients as the links between nodes. Clinicians are linked if they have seen the same patients within a fixed time period: 1, 2 or 3 years. The second network analysis will include patients as nodes, clinicians are linked through patients. The following network metrics will be examined: Node Degree Analysis, Shortest Path Analysis, Spectral Analysis, and Clustering Analysis. Quality of care for clinic will be obtained from the VA office of quality and performance and will include measures across three domains: Access, Clinical and Satisfaction.


Publications

- M. Parchman, C. Scoglio, and P. Schumm, "Understanding the Implementation of Evidence-Based Care: A Structural Network Approach," Implementation Science 2011, 6:14, doi:10.1186/1748-5908-6-14, 2011.

http://www.implementationscience.com/content/6/1/14




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