Understanding clinician connections to inform efforts to promote high-quality inflammatory bowel disease care.
Understanding clinician connections to inform efforts to promote high-quality inflammatory bowel disease care.
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DOI：
10.1371/journal.pone.0279441
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发表时间：
2022
期刊：
影响因子：
3.7
通讯作者：
Waljee, Akbar K.
中科院分区：
文献类型：
--
作者：
Cohen-Mekelburg, Shirley;Van, Tony;Yu, Xianshi;Costa, Deena Kelly;Manojlovich, Milisa;Saini, Sameer;Gilmartin, Heather;Admon, Andrew J.;Resnicow, Ken;Higgins, Peter D. R.;Siwo, Geoffrey;Zhu, Ji;Waljee, Akbar K.
高度联系的个体在他们的社交网络中有效地传播信息。为了将这一概念应用于炎症性肠病（IBD）的治疗，并为传播高质量治疗的网络干预奠定基础，我们评估了提高高度联系的临床医生IBD实践的必要性。我们的目的是检查治疗IBD患者的高度联系的临床医生是否比联系较少的临床医生更有可能提供高质量的治疗。我们使用网络分析来检查2015-2018年期间在退伍军人健康管理局共享IBD患者的临床医生之间的联系。我们创建了一个由临床医生组成的网络，由共同的病人连接起来。我们使用程度中心性（与临床医生共享患者的临床医生数量）、亲密中心性（通过共享联系人接触到其他临床医生）和中间中心性（临床医生与没有其他联系的临床医生之间的联系程度）来量化临床医生的联系。使用加权线性回归，我们检查了每个连接测量与两个IBD质量指标之间的关联：低长期类固醇使用和高类固醇保留治疗使用。我们确定了62971名IBD患者，并将他们与1655名胃肠病学家和7852名初级保健提供者联系起来。具有更多联系（程度）的临床医生更有可能表现出高质量的治疗（较少延长类固醇治疗β -0.0268, 95%CI -0.0427, -0.0110，更多保留类固醇治疗β - 0.0967, 95%CI 0.0128, 0.1805）。与其他未联系的临床医生联系的临床医生（中间值）显示类固醇使用时间更长（β 0.0003, 95%CI 0.0001, 0.0006）。变异的存在比它的大小更重要。联系较多的临床医生比联系较少的临床医生提供更多高质量的IBD治疗，并且可能处于传播高质量IBD治疗的干预措施的有利位置。然而，那些与其他医生没有联系的临床医生联系起来的临床医生更有可能表现出低质量的IBD治疗。在利用其地位传播高质量护理之前，需要努力提高其质量。
Highly connected individuals disseminate information effectively within their social network. To apply this concept to inflammatory bowel disease (IBD) care and lay the foundation for network interventions to disseminate high-quality treatment, we assessed the need for improving the IBD practices of highly connected clinicians. We aimed to examine whether highly connected clinicians who treat IBD patients were more likely to provide high-quality treatment than less connected clinicians. We used network analysis to examine connections among clinicians who shared patients with IBD in the Veterans Health Administration between 2015–2018. We created a network comprised of clinicians connected by shared patients. We quantified clinician connections using degree centrality (number of clinicians with whom a clinician shares patients), closeness centrality (reach via shared contacts to other clinicians), and betweenness centrality (degree to which a clinician connects clinicians not otherwise connected). Using weighted linear regression, we examined associations between each measure of connection and two IBD quality indicators: low prolonged steroids use, and high steroid-sparing therapy use. We identified 62,971 patients with IBD and linked them to 1,655 gastroenterologists and 7,852 primary care providers. Clinicians with more connections (degree) were more likely to exhibit high-quality treatment (less prolonged steroids beta -0.0268, 95%CI -0.0427, -0.0110, more steroid-sparing therapy beta 0.0967, 95%CI 0.0128, 0.1805). Clinicians who connect otherwise unconnected clinicians (betweenness) displayed more prolonged steroids use (beta 0.0003, 95%CI 0.0001, 0.0006). The presence of variation is more relevant than its magnitude. Clinicians with a high number of connections provided more high-quality IBD treatments than less connected clinicians, and may be well-positioned for interventions to disseminate high-quality IBD care. However, clinicians who connect clinicians who are otherwise unconnected are more likely to display low-quality IBD treatment. Efforts to improve their quality are needed prior to leveraging their position to disseminate high-quality care.
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DOI：
10.1016/s0140-6736(15)60095-2
发表时间：
2015-07-11
期刊：
Lancet (London, England)
影响因子：
--
作者：
Kim DA;Hwong AR;Stafford D;Hughes DA;O'Malley AJ;Fowler JH;Christakis NA
通讯作者：
Christakis NA
影响因子：
12.6
作者：
Regueiro, Miguel;Click, Benjamin;Szigethy, Eva
通讯作者：
Szigethy, Eva
影响因子：
4.9
作者：
Oliver, Brant J.;Kennedy, Alice M.;Nelson, Eugene C.
通讯作者：
Nelson, Eugene C.
影响因子：
1.7
作者：
Atreja A;Khan S;Rogers JD;Otobo E;Patel NP;Ullman T;Colombel JF;Moore S;Sands BE;HealthPROMISE Consortium Group
通讯作者：
HealthPROMISE Consortium Group
影响因子：
3.7
作者：
Waljee AK;Wiitala WL;Govani S;Stidham R;Saini S;Hou J;Feagins LA;Khan N;Good CB;Vijan S;Higgins PD
通讯作者：
Higgins PD