Methodology for supervised optimization of the construction of physician shared-patient networks.

Abstract

There is growing use of shared-patient physician networks in health services research and practice, but minimal study of the consequences of decisions made in constructing them. To address this gap, we surveyed physician employees of a National Physician Organization (NPO) on their peer physician relationships. Using the physicians' survey nominations as ground truths, we evaluated the diagnostic accuracy of shared-patient edge-weights and the optimal construction of physician networks from sequences of patient-physician encounters. To further improve diagnostic accuracy, we optimized network construction with respect to the within-dyad difference and summation of edge-strength (two orthogonal measures), optimally combining them to form a final edge-weight. To achieve these goals, we develop statistical procedures to quantify the extent that directionality and other features of referral paths yield edge-weights with improved diagnostic properties. We also develop network models of the survey nominations incorporating directed (edge) and undirected (dyadic) shared-patient network measures as edge and dyad attributes to demonstrate that the measurement of the network as a whole is improved. Finally, we estimate the association of the physicians' centrality in the NPO shared-patient network (a sociocentric feature that cannot be evaluated for the partially-measured survey-based network) with their beliefs regarding physician peer-influence.