The Influence of Provider Connectedness on Continuity of Care and Hospital Readmissions in Patients With COPD: A Claims Data Based Social Network Study.

IF 2.3 4区 医学 Q2 RESPIRATORY SYSTEM Chronic Obstructive Pulmonary Diseases-Journal of the Copd Foundation Pub Date : 2023-01-25 DOI:10.15326/jcopdf.2022.0359
Johanna Forstner, Jan Koetsenruijjter, Christine Arnold, Gunter Laux, Michel Wensing
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Abstract

Background: Hospital readmission rates are very high in patients with chronic obstructive pulmonary disease (COPD). Continuity of care (CoC) with general practitioners (GPs) and ambulatory specialists can impact readmission rates. This study aimed to identify shared patient networks of ambulatory care physicians and to examine the effect of provider connectedness on CoC and hospital readmissions.

Methods: A retrospective observational study was conducted in claims data from the years 2016 to 2018 in patients with COPD (aged 40 years or older; hospital stay in 2017). Linkages between GPs, pneumologists, and cardiologists were determined on the basis of shared patients. Multilevel regression models were used to analyze the impact of provider connectedness, operationalized by several social network characteristics, on continuity of care (sequential continuity [SECON] index) and hospital readmission rates.

Results: A total of 7294 patients linked to 3673 GPs were available for analysis. Closeness centrality (β=- 0.029) and the external-internal (EI)-index (β =0.037) impacted on the SECON index. The EI-index (odds ratio [OR]=1.25) and degree centrality (OR=1.257) impacted 30-day readmission. Network density (OR=0.811) and the SECON index (OR=1.121) affected the likelihood of a 90-day readmission. None of the predictors had a significant impact on 180-day and 365-day readmissions.

Conclusions: Ambulatory care providers' connectedness showed some effects on hospital readmissions and CoC in patients with COPD up to 90 days after hospital discharge, but the additional predictive power is limited.

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提供者连通性对慢性阻塞性肺病患者护理连续性和再入院的影响:一项基于索赔数据的社会网络研究
背景:慢性阻塞性肺疾病(COPD)患者的再入院率非常高。全科医生(gp)和门诊专家的连续性护理(CoC)会影响再入院率。本研究旨在确定门诊医生的共享患者网络,并检查提供者连通性对CoC和医院再入院的影响。方法:回顾性观察研究2016 - 2018年COPD患者(40岁及以上;2017年住院时间)。全科医生、肺科医生和心脏病专家之间的联系是基于共同的患者确定的。使用多水平回归模型来分析由几个社会网络特征操作的提供者连通性对护理连续性(顺序连续性[SECON]指数)和医院再入院率的影响。结果:共有7294名患者与3673名GPs相关,可用于分析。封闭性中心性(β=- 0.029)和内外(EI)指数(β= 0.037)对SECON指数有影响。ei指数(比值比[OR]=1.25)和度中心性(OR=1.257)影响30天再入院。网络密度(OR=0.811)和SECON指数(OR=1.121)影响90天再入院的可能性。没有一项预测因子对180天和365天再入院有显著影响。结论:门诊护理提供者的连通性对慢性阻塞性肺病患者出院后90天的再入院率和CoC有一定影响,但额外的预测能力有限。
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来源期刊
CiteScore
3.70
自引率
8.30%
发文量
45
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