Variation in Provider Connectedness Associates With Outcomes of Inflammatory Bowel Diseases in an Analysis of Data From a National Health System

Abstract

Background & aims: Inflammatory bowel diseases (IBD) often require multidisciplinary care with tight coordination among providers. Provider connectedness, a measure of the relationship among providers, is an important aspect of care coordination that has been linked to higher quality care. We aimed to assess variation in provider connectedness among medical centers, and to understand the association between this established measure of care coordination and outcomes of patients with IBD.

Methods: We conducted a national cohort study of 32,949 IBD patients with IBD from 2005 to 2014. We used network analysis to examine provider connectedness, defined using network properties that measure the strength of the collaborative relationship, team cohesiveness, and between-facility collaborations. We used multilevel modeling to examine variations in provider connectedness and association with patient outcomes.

Results: There was wide variation in provider connectedness among facilities in complexity, rural designation, and volume of patients with IBD. In a multivariable model, patients followed in a facility with team cohesiveness (odds ratio, 0.38; 95% CI, 0.16-0.88) and where providers often collaborated with providers outside their facility (odds ratio, 0.48; 95% CI, 0.31-0.75) were less likely to have clinically active disease, defined by a composite of outpatient flare, inpatient flare, and IBD-related surgery.

Conclusions: A national study found evidence for heterogeneity in patient-sharing among IBD care teams. Patients with IBD seen at health centers with higher provider connectedness appear to have better outcomes. Understanding provider connectedness is a step toward designing network-based interventions to improve coordination and quality of care.

Keywords: Connection; Crohn’s Disease; Interaction; Ulcerative Colitis.

Figure 1.

Provider connectedness. (A) An example of a facility-specific network structure, where nodes are providers (PCP, gastroenterologist, surgeon and edges represent patient-sharing collaborations. (B) Conceptual model of the relationship between providers using network properties.

Figure 2.

Distribution of network properties by facility (y-axis represents unique facilities, and x-axis the quantitative measurement). The mean number of collaborations per provider dyad by facility was 1.40 (standard deviation [SD], 0.18). The repeated tie fraction by facility had a mean of 0.20 (SD, 0.05) with a range of 0 to 1 with 1 representing the case where each collaboration involves at least 2 patients. The mean ratio of patients who were shared across facilities was 0.24 (SD, 0.11). The mean clustering coefficient across facilities was 0.36 (SD, 0.07) on a range of 0 to 1 with 1 representing the case where whenever 2 providers have common collaborator, they themselves collaborate.

Figure 3.

A sample of 6 of the 130 facility networks with different patient-sharing structures.