Using administrative data to identify naturally occurring networks of physicians.
Using administrative data to identify naturally occurring networks of physicians.
复制标题
DOI：
10.1097/mlr.0b013e3182977991
复制
发表时间：
2013-08
期刊：
影响因子：
3
通讯作者：
Christakis NA
中科院分区：
文献类型：
--
作者：
Landon BE;Onnela JP;Keating NL;Barnett ML;Paul S;O'Malley AJ;Keegan T;Christakis NA
医生自然形成网络。网络可以形成一个合理的基础，负责医疗机构（ACO）的医疗保险受益人的定义人群。使用网络科学的方法来识别可能最适合成为ACO的自然发生的医生网络。使用全国代表性的索赔数据，从医疗保险计划为CY 2006年的51个医院转诊地区（HRR），我们使用了网络科学为基础的社区检测算法，以确定可能有预先建立的关系的医生群体。我们检查了社区内提供的护理比例，并将我们的结果与围绕单个医院组织的潜在ACO进行了比较。我们研究了来自51个HRR的4，586，044名医疗保险受益人，他们被68，288名在这些HRR中执业的活跃医生看到。中位社区网络ACO有150名医生，5，928名患者，而中位医院网络ACO有96名医生，3，276名患者。77%的医生访问发生在以社区为基础的网络中的医生，而以医院为基础的网络中的医生为56%;然而，只有8%的专家访问是以医院为基础的网络中的专家，而以社区为基础的网络中的专家访问为60%。一些市场似乎比其他市场更适合开发基于网络社区的ACO。我们提出了一种新的方法来识别可能容易充当ACO的医生群体。以这种自然和系统的方式识别和定义的有机网络已经有了表现出密切工作关系的医生，重要的是，他们将绝大多数护理保持在网络中。
Physicians naturally form networks. Networks could form a rational basis for Accountable Care Organizations (ACOs) for defined populations of Medicare beneficiaries. To use methods from network science to identify naturally occurring networks of physicians that might be best suited to becoming ACOs. Using nationally representative claims data from the Medicare program for CY 2006 on 51 hospital referral regions (HRRs), we used a network-science based community-detection algorithm to identify groups of physicians likely to have pre-established relationships. We examined the proportion of care delivered within communities and compared our results to potential ACOs organized around single hospitals. We studied 4,586,044 Medicare beneficiaries from 51 HRRs who were seen by 68,288 active physicians practicing in those HRRs. The median community-based network ACO had 150 physicians with 5,928 ties whereas the median hospital-based network ACO had 96 physicians with 3,276 ties. Seventy-seven percent of physician visits occurred with physicians in the community-based networks as compared with 56% with physicians in the hospital-based networks; however, just 8% of specialist visits were to specialists within the hospital-based networks as compared with 60% of specialist visits within the community-based networks. Some markets seemed better suited to developing ACOs based on network communities than others. We present a novel approach to identifying groups of physicians that might readily function as ACOs. Organic networks identified and defined in this natural and systematic manner already have physicians who exhibit close working relationships, and who, importantly, keep the vast majority of care within the networks.