Cooperation networks of ambulatory healthcare providers: exploration of mechanisms that influence coordination of care

背景：如果不将发现转化为实际实施的干预措施、技术或政策，对研究的投资就是浪费。然而，有压倒性的证据表明研究浪费了。在医疗保健领域，实施战略的效果好坏参半，平均而言，效果适中。由于越来越多的患者患有复杂的慢性健康问题，以及医疗保健服务的持续专业化，实施科学需要考虑到许多患者从不同的医疗保健提供者那里获得医疗保健。本研究基于社会网络的视角，结合医疗服务提供者和患者对合作网络的看法，探讨哪些机制有助于医疗服务提供者之间的合作。目的：本研究的总体目标是探索医疗服务提供者专业网络中的哪些机制有助于医疗服务的合作和协调。具体目标是：a)从患者和提供者的角度描述和探索专业网络的变化；b)探索哪些网络相关机制在合作和协调中发挥作用；假设的网络因素是意见领袖、中央护理提供者、网络密度、网络同质性、病例协调、网络互惠和网络构成的变化。方法：在申请者的初步研究的基础上，计划在现实世界中进行两项连续的研究。1)一项对医疗保健提供者网络的观察性研究，涉及来自40个普通诊所和大约320个医疗保健提供者的600名慢性(动脉粥样硬化相关)疾病患者。2)对56名医疗保健提供者和24名患者的定性访谈研究，以及对10-15名利益相关者和专家的焦点小组研究，这两项研究的重点都是确定网络相关机制。观点：该项目将为医疗保健合作和协调的基础机制提供知识。这将有助于设计供应商网络的创新实施战略和措施，可用于今后的研究。

Background: Investments in research are wasted, if discoveries are not translated into interventions, technologies or policies, which are implemented in practice. Nevertheless, there is overwhelming evidence of research waste. In healthcare, the effects of implementation strategies have been mixed and, on average, moderate. Due to increasing numbers of patients with complex chronic health problems and ongoing specialisation in healthcare delivery, implementation science needs to take into account that many patients receive healthcare from different healthcare providers. Based on a social networks perspective, this project explores which mechanisms contribute to cooperation between healthcare providers, considering both the provider and the patient views on cooperation networks.Objectives: The overall aim of the proposed research project is to explore which mechanisms in the professional networks of healthcare providers contribute to cooperation and coordination of healthcare. Specific objectives are: a) to describe and explore variation in professional networks from the perspective of patients and providers; b) to explore which network-related mechanisms play a role in cooperation and coordination; Hypothesised network-factors are opinion leaders, central care providers, network density, network homogeneity, case coordination, network reciprocity, and change of network composition. Methods: Building on pilot studies of the applicant, two consecutive studies are planned in real-world settings. 1) An observational study of healthcare provider networks, involving 600 patients with chronic (atherosclerosis-related) disease from 40 general practices and approximately 320 healthcare providers. 2) Qualitative interview study with 56 healthcare providers and 24 patients, and a focus groups study with 10-15 stakeholders and experts, which are both focused on identifying network-related mechanisms. Perspective: The project will provide knowledge into mechanisms, which underlie cooperation and coordination of healthcare. This will contribute to the design of innovative implementation strategies and measures of provider-networks, which can be used in future research.