Clin Gastroenterol Hepatol. 2021 Nov;19(11):2302-2311.e1. doi: 10.1016/j.cgh.2020.08.028.Epub 2020 Aug 13.

Shirley Cohen-Mekelburg ¹, Xianshi Yu ², Deena Costa ³, Timothy P Hofer ⁴, Sarah Krein ⁵, John Hollingsworth ⁶, Wyndy Wiitala ⁷, Sameer Saini ⁸, Ji Zhu ², Akbar Waljee ⁸

Author information

1. Division of Gastroenterology & Hepatology, University of Michigan, Ann Arbor, Michigan; VA Center for Clinical Management Research, Ann Arbor, Michigan; Institute of Health Policy and Innovation, University of Michigan, Ann Arbor, Michigan. Electronic address: shcohen@umich.edu.

2. Department of Statistics, University of Michigan, Ann Arbor, Michigan.

3. Institute of Health Policy and Innovation, University of Michigan, Ann Arbor, Michigan; University of Michigan School of Nursing, Ann Arbor, Michigan.

4. VA Center for Clinical Management Research, Ann Arbor, Michigan; Institute of Health Policy and Innovation, University of Michigan, Ann Arbor, Michigan; Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan.

5. VA Center for Clinical Management Research, Ann Arbor, Michigan; Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan.

6. Institute of Health Policy and Innovation, University of Michigan, Ann Arbor, Michigan; Department of Urology, University of Michigan, Ann Arbor, Michigan.

7. VA Center for Clinical Management Research, Ann Arbor, Michigan.

8. Division of Gastroenterology & Hepatology, University of Michigan, Ann Arbor, Michigan; VA Center for Clinical Management Research, Ann Arbor, Michigan; Institute of Health Policy and Innovation, University of Michigan, Ann Arbor, Michigan.

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.