Summary
Background: Unnecessary hospital readmissions are one source of escalating costs that may be
reduced through improved care coordination, but how best to design and evaluate coordination
programs is poorly understood. Measuring patient flow between service visits could
support decisions for coordinating care, particularly for conditions such as congestive
heart failure (CHF) which have high morbidity, costs, and hospital readmission rates.
Objective: To determine the feasibility of using network analysis to explore patterns of service
delivery for patients with CHF in the context of readmissions.
Methods: A retrospective cohort study used de-identified records for patients 18 years with
an ICD-9 diagnosis code 428.0–428.9, and service visits between July 2011 and June
2012. Patients were stratified by admission outcome. Traditional and novel network
analysis techniques were applied to characterize care patterns.
Results: Patients transitioned between services in different order and frequency depending
on admission status. Patient-to-service CoUsage networks were diffuse suggesting unstructured
flow of patients with no obvious coordination hubs. In service-to-service Transition
networks a specialty heart failure service was on the care path to the most other
services for never admitted patients, evidence of how specialist care may prevent
hospital admissions for some patients. For patients admitted once, transitions expanded
for a clinic-based internal medicine service which clinical experts identified as
a Patient Centered Medical Home implemented in the first month for which we obtained
data.
Conclusions: We detected valid patterns consistent with a targeted care initiative, which experts
could understand and explain, suggesting the method has utility for understanding
coordination. The analysis revealed strong but complex patterns that could not be
demonstrated using traditional linear methods alone. Network analysis supports measurement
of real world health care service delivery, shows how transitions vary between services
based on outcome, and with further development has potential to inform coordination
strategies.
Citation: Merrill JA, Sheehan BM, Carley KM, Stetson PD. Transition networks in a cohort of
patients with congestive heart failure: a novel application of informatics methods
to inform care coordination. Appl Clin Inform 2015; 6: 548–564
http://dx.doi.org/10.4338/ACI-2015-02-RA-0021
Keywords
Care coordination - patient care management - network analysis - heart failure - healthcare
systems
