TY - GEN
T1 - Provider networks in the neonatal intensive care unit associate with length of stay
AU - Kim, Cindy
AU - Lehmann, Christoph U.
AU - Hatch, Dupree
AU - Schildcrout, Jonathan S.
AU - France, Daniel J.
AU - Chen, You
N1 - Funding Information:
The research reported in this publication was supported by the National Library of Medicine of the National Institutes of Health under Award Number R01LM012854. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Publisher Copyright:
© 2019 IEEE.
PY - 2019/12
Y1 - 2019/12
N2 - We strive to understand care coordination structures of multidisciplinary teams and to evaluate their effect on post-surgical length of stay (PSLOS) in the Neonatal Intensive Care Unit (NICU). Electronic health record (EHR) data were extracted for 18 neonates, who underwent gastrostomy tube placement surgery at the Vanderbilt University Medical Center NICU. Based on providers' interactions with the EHR (e.g. viewing, documenting, ordering), provider-provider relations were learned and used to build patient-specific provider networks representing the care coordination structure. We quantified the networks using standard network analysis metrics (e.g., in-degree, out-degree, betweenness centrality, and closeness centrality). Coordination structure effectiveness was measured as the association between the network metrics and PSLOS, as modeled by a proportional-odds, logistical regression model. The 18 provider networks exhibited various team compositions and various levels of structural complexity. Providers, whose patients had lower PSLOS, tended to disperse patient-related information to more colleagues within their network than those, who treated higher PSLOS patients (P = 0.0294). In the NICU, improved dissemination of information may be linked to reduced PSLOS. EHR data provides an efficient, accessible, and resource-friendly way to study care coordination using network analysis tools. This novel methodology offers an objective way to identify key performance and safety indicators of care coordination and to study dissemination of patient-related information within care provider networks and its effect on care. Findings should guide improvements in the EHR system design to facilitate effective clinical communications among providers.
AB - We strive to understand care coordination structures of multidisciplinary teams and to evaluate their effect on post-surgical length of stay (PSLOS) in the Neonatal Intensive Care Unit (NICU). Electronic health record (EHR) data were extracted for 18 neonates, who underwent gastrostomy tube placement surgery at the Vanderbilt University Medical Center NICU. Based on providers' interactions with the EHR (e.g. viewing, documenting, ordering), provider-provider relations were learned and used to build patient-specific provider networks representing the care coordination structure. We quantified the networks using standard network analysis metrics (e.g., in-degree, out-degree, betweenness centrality, and closeness centrality). Coordination structure effectiveness was measured as the association between the network metrics and PSLOS, as modeled by a proportional-odds, logistical regression model. The 18 provider networks exhibited various team compositions and various levels of structural complexity. Providers, whose patients had lower PSLOS, tended to disperse patient-related information to more colleagues within their network than those, who treated higher PSLOS patients (P = 0.0294). In the NICU, improved dissemination of information may be linked to reduced PSLOS. EHR data provides an efficient, accessible, and resource-friendly way to study care coordination using network analysis tools. This novel methodology offers an objective way to identify key performance and safety indicators of care coordination and to study dissemination of patient-related information within care provider networks and its effect on care. Findings should guide improvements in the EHR system design to facilitate effective clinical communications among providers.
KW - Audit Logs
KW - Care Coordination
KW - Electronic Health Records (EHR)
KW - Neonatal Intensive Care Unit (NICU)
KW - Network Analysis
KW - Post-Surgical Length of Stay (PSLOS)
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U2 - 10.1109/CIC48465.2019.00024
DO - 10.1109/CIC48465.2019.00024
M3 - Conference contribution
C2 - 32637942
AN - SCOPUS:85080951529
T3 - Proceedings - 2019 IEEE 5th International Conference on Collaboration and Internet Computing, CIC 2019
SP - 127
EP - 134
BT - Proceedings - 2019 IEEE 5th International Conference on Collaboration and Internet Computing, CIC 2019
PB - Institute of Electrical and Electronics Engineers Inc.
T2 - 5th IEEE International Conference on Collaboration and Internet Computing, CIC 2019
Y2 - 12 December 2019 through 14 December 2019
ER -