An Outcome-Weighted Network Model for Characterizing Collaboration

Abstract

Shared patient encounters form the basis of collaborative relationships, which are crucial to the success of complex and interdisciplinary teamwork in healthcare. Quantifying the strength of these relationships using shared risk-adjusted patient outcomes provides insight into interactions that occur between healthcare providers. We developed the Shared Positive Outcome Ratio (SPOR), a novel parameter that quantifies the concentration of positive outcomes between a pair of healthcare providers over a set of shared patient encounters. We constructed a collaboration network using hospital emergency department patient data from electronic health records (EHRs) over a three-year period. Based on an outcome indicating patient satisfaction, we used this network to assess pairwise collaboration and evaluate the SPOR. By comparing this network of 574 providers and 5,615 relationships to a set of networks based on randomized outcomes, we identified 295 (5.2%) pairwise collaborations having significantly higher patient satisfaction rates. Our results show extreme high- and low-scoring relationships over a set of shared patient encounters and quantify high variability in collaboration between providers. We identified 29 top performers in terms of patient satisfaction. Providers in the high-scoring group had both a greater average number of associated encounters and a higher percentage of total encounters with positive outcomes than those in the low-scoring group, implying that more experienced individuals may be able to collaborate more successfully. Our study shows that a healthcare collaboration network can be structurally evaluated to characterize the collaborative interactions that occur between healthcare providers in a hospital setting.

Fig 1. A simple example of the graph data model showing five actions performed by four providers during two encounters.

(A) Providers 1, 2, and 3 each performed one activity during encounter 1, while provider 4 performed two activities during encounter 2. A hyperedge was used to represent an instance of activity during an encounter. Notice that both Provider 3 and Provider 4 performed a “Nursing Assessment” activity during different encounters. (B) Without hyperedges between the provider and the encounter nodes, it would not be possible to determine, for example, which provider performed the “Nursing Assessment" during encounter 2.

Fig 2. The collaboration evaluation strategy used in this study.

Fig 3. SPOR value distributions.

The distribution of SPOR values across the provider collaboration network as the number of collaborations required between providers for inclusion into the network was increased. The distribution stabilized when the lower limit on shared encounters was set at six. The x-axis value shown is on a log₂ scale, which means –1 is equivalent to a SPOR of 0.5 and a value of 1 is equivalent to a SPOR of 2, while the expected SPOR value is 0.

Fig 4. An example provider collaboration network showing 21 providers and 21 SPOR relationships.

Properties associated with the highlighted edge (yellow) including the SPOR coefficient, the number of shared patient encounters between the two providers (num_collabs), and an indication of the significance of the SPOR coefficient (p-value) are shown in the bottom left. The proximity of nodes to each other is based on the SPOR coefficient, with high-scoring relationships being shorter in length than low-scoring relationships.