PLoS One. 2022 Dec 27;17(12):e0279441. doi: 10.1371/journal.pone.0279441. eCollection 2022.

Shirley Cohen-Mekelburg ^1 2, Tony Van ¹, Xianshi Yu ³, Deena Kelly Costa ^4 5, Milisa Manojlovich ^4 5, Sameer Saini ^1 2, Heather Gilmartin ⁶, Andrew J Admon ^7 8, Ken Resnicow ⁹, Peter D R Higgins ², Geoffrey Siwo ², Ji Zhu ³, Akbar K Waljee ^1 2

Author information

¹VA Center for Clinical Management Research, LTC Charles Kettles VA Medical Center, Ann Arbor, Michigan, United States of America.

²Division of Gastroenterology & Hepatology, University of Michigan Medicine, Ann Arbor, Michigan, United States of America.

³Department of Statistics, University of Michigan Medicine, Ann Arbor, Michigan, United States of America.

⁴School of Nursing, Yale University, New Haven, Connecticut, United States of America.

⁵Section on Pulmonary, Critical Care & Sleep Medicine, Department of Internal Medicine, Yale University, New Haven, Connecticut, United States of America.

⁶Denver/Seattle Center of Innovation, VA Eastern Colorado Healthcare System, Aurora, Colorado, United States of America.

⁷Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan Medicine, Ann Arbor, Michigan, United States of America.

⁸Pulmonary Service, LTC Charles Kettles VA Medical Center, Ann Arbor, Michigan, United States of America.

⁹Department of Health Education and Health Behavior, University of Michigan School of Public Health, Ann Arbor, Michigan, United States of America.

Abstract

Background: Highly connected individuals disseminate information effectively within their social network. To apply this concept to inflammatory bowel disease (IBD) care and lay the foundation for network interventions to disseminate high-quality treatment, we assessed the need for improving the IBD practices of highly connected clinicians. We aimed to examine whether highly connected clinicians who treat IBD patients were more likely to provide high-quality treatment than less connected clinicians.

Methods: We used network analysis to examine connections among clinicians who shared patients with IBD in the Veterans Health Administration between 2015-2018. We created a network comprised of clinicians connected by shared patients. We quantified clinician connections using degree centrality (number of clinicians with whom a clinician shares patients), closeness centrality (reach via shared contacts to other clinicians), and betweenness centrality (degree to which a clinician connects clinicians not otherwise connected). Using weighted linear regression, we examined associations between each measure of connection and two IBD quality indicators: low prolonged steroids use, and high steroid-sparing therapy use.

Results: We identified 62,971 patients with IBD and linked them to 1,655 gastroenterologists and 7,852 primary care providers. Clinicians with more connections (degree) were more likely to exhibit high-quality treatment (less prolonged steroids beta -0.0268, 95%CI -0.0427, -0.0110, more steroid-sparing therapy beta 0.0967, 95%CI 0.0128, 0.1805). Clinicians who connect otherwise unconnected clinicians (betweenness) displayed more prolonged steroids use (beta 0.0003, 95%CI 0.0001, 0.0006). The presence of variation is more relevant than its magnitude.

Conclusions: Clinicians with a high number of connections provided more high-quality IBD treatments than less connected clinicians, and may be well-positioned for interventions to disseminate high-quality IBD care. However, clinicians who connect clinicians who are otherwise unconnected are more likely to display low-quality IBD treatment. Efforts to improve their quality are needed prior to leveraging their position to disseminate high-quality care.