Variation in Patient-Sharing Networks of Physicians Across the United States

Landon, Bruce E.; Keating, Nancy L.; Barnett, Michael L.; Onnela, Jukka‐Pekka; Paul, Sudeshna; O’Malley, A. James; Keegan, Thomas; Christakis, Nicholas A.

doi:10.1001/jama.2012.7615

Cited by 215 publications

(286 citation statements)

References 28 publications

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“…[15][16][17][18][19][20] The underlying concept is based on the premise that providers exchange information and establish rapport in the process of providing care to shared patients; providers who share a greater number of patients should therefore have stronger collaborative relationships and will be able to provide better coordinated care. Several studies have demonstrated a direct correlation between the cost of care and hospital readmission rates for individual patients and the number of patients shared among the providers caring for them.…”

Section: Introductionmentioning

confidence: 99%

Provider Patient-Sharing Networks and Multiple-Provider Prescribing of Benzodiazepines

et al. 2015

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Section: Introductionmentioning

confidence: 99%

Provider Patient-Sharing Networks and Multiple-Provider Prescribing of Benzodiazepines

et al. 2015

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“…Landon et al demonstrated that these shared patients define networks that vary in structure by region. 12 Physicians with shared patients were more often located geographically close or based at the same hospital. Further, they suggest that regions with strong community networks-defined by the number of shared patients between any two physicians-might form the basis of a well-functioning ACO.…”

Section: Discussionmentioning

confidence: 99%

“…Other studies examining networks of providers defined by shared patients have used Medicare claims as a single data source. 12,13,15,16 Like those studies, we miss shared patients, collaborative pairs, and constellations around patients covered by other payors. To mitigate this limitation, we chose regions with substantial market penetration by health plan.…”

Section: Discussionmentioning

confidence: 99%

Provider Collaboration: Cohesion, Constellations, and Shared Patients

Mandl

Olson

Mines³

et al. 2014

J GEN INTERN MED

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BACKGROUND: There is a natural assumption that quality and efficiency are optimized when providers consistently work together and share patients. Diversity in composition and recurrence of groups that provide face-toface care to the same patients has not previously been studied. OBJECTIVE: Claims data enable identification of the constellation of providers caring for a single patient. To indirectly measure teamwork and provider collaboration, we measure recurrence of provider constellations and cohesion among providers. DESIGN: Retrospective analysis of commercial healthcare claims from a single insurer. PARTICIPANTS: Patients with claims for office visits and their outpatient providers. To maximize capture of provider panels, the cohort was drawn from the four regions with the highest plan coverage. Regional outpatient provider networks were constructed with providers as nodes and number of shared patients as links. MAIN MEASURES: Measures of cohesion and stability of provider constellations derived from the networks of providers to quantify patient sharing. RESULTS: For 10,325 providers and their 521,145 patients, there were 2,641,933 collaborative provider pairs sharing at least one patient. Fifty-four percent only shared a single patient, and 19 % shared two. Of 15,449,835 unique collaborative triads, 92 % shared one patient, 5 % shared two, and 0.2 % shared ten or more. Patient constellations had a median of four providers. Any precise constellation recurred rarely-89 % with exactly two providers shared just one patient and only 4 % shared over two; 97 % of constellations with exactly three providers shared just one patient. Four percent of constellations with 2+ providers were not at all cohesive, sharing only the hub patient. In the remaining constellations, a median of 93 % of provider pairs shared at least one additional patient beyond the hub patient.CONCLUSION: Stunning variability in the constellations of providers caring for patients may challenge underlying assumptions about the current state of teamwork in healthcare.KEYWORDS: accountable care organizations; patient care team; physician's practice patterns.

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“…18 HRRs have been utilized widely to characterize geographic variation in healthcare quality and delivery. [19][20][21] Among 6,514,278 enrollees eligible for the HEDIS measure, we excluded 86,131 who died during the measurement year, who were outside the U.S., or those enrolled in health plans outside the U.S. We further excluded 8,707 observations from six plans that erroneously reported a greater rate of enrollees receiving two or more HRMs than the rate of enrollees receiving one or more HRMs. After all exclusions, the final study sample consisted of 6,204,824 enrollees.…”

Section: Study Populationmentioning

confidence: 99%

Receipt of High Risk Medications among Elderly Enrollees in Medicare Advantage Plans

Qato

Trivedi

2012

J GEN INTERN MED

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In fully adjusted models, females had a 10.6 (95 % CI: 10.0-11.2) higher percentage point rate of receipt than males, and residence in any of the Southern United States divisions was associated with a greater than 10 percentage point higher rate, as compared with the reference New England division. Higher rates were also observed among enrollees with low personal income (6.5 percentage points, 95 % CI: 5.5-7.5), relative to those without low income and those residing in areas in the lowest quintile of socioeconomic status (2.7 points, 95 % CI: 1.9-3.4) relative to persons residing in the highest quintile. Enrollees ≥ 85 years old, black enrollees, and other minority groups were less likely to receive these medications. Over 38 % of MA enrollees residing in the hospital referral region of Albany, Georgia received at least one HRM, a rate four times higher than the referral region with the lowest rate (Mason City, Iowa). CONCLUSIONS: Use of HRMs among MA enrollees varies widely by geographic region. Persons living in the Southern region of the U.S., whites, women, and persons of low personal income and socioeconomic status are more likely to receive HRMs.

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Variation in Patient-Sharing Networks of Physicians Across the United States

Cited by 215 publications

References 28 publications

Provider Patient-Sharing Networks and Multiple-Provider Prescribing of Benzodiazepines

Provider Patient-Sharing Networks and Multiple-Provider Prescribing of Benzodiazepines

Provider Collaboration: Cohesion, Constellations, and Shared Patients

Receipt of High Risk Medications among Elderly Enrollees in Medicare Advantage Plans

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