tailieunhanh - báo cáo khoa học: "Understanding the implementation of evidencebased care: A structural network approach"

Tuyển tập báo cáo các nghiên cứu khoa học quốc tế ngành y học dành cho các bạn tham khảo đề tài: Understanding the implementation of evidencebased care: A structural network approach | Parchman et al. Implementation Science 2011 6 14 http content 6 1 14 IMPLEMENTATION SCIENCE Implementation Science RESEARCH Open Access Understanding the implementation of evidencebased care A structural network approach Michael L Parchman1 2 Caterina M Scoglio3 Phillip Schumm3 Abstract Background Recent study of complex networks has yielded many new insights into phenomenon such as social networks the internet and sexually transmitted infections. The purpose of this analysis is to examine the properties of a network created by the co-care of patients within one region of the Veterans Health Affairs. Methods Data were obtained for all outpatient visits from 1 October 2006 to 30 September 2008 within one large Veterans Integrated Service Network. Types of physician within each clinic were nodes connected by shared patients with a weighted link representing the number of shared patients between each connected pair. Network metrics calculated included edge weights node degree node strength node coreness and node betweenness. Log-log plots were used to examine the distribution of these metrics. Sizes of k-core networks were also computed under multiple conditions of node removal. Results There were 4 310 465 encounters by 266 710 shared patients between 722 provider types nodes across 41 stations or clinics resulting in 34 390 edges. The number of other nodes to which primary care provider nodes have a connection is 42 greater than that of general surgeons and two and one-half times as high as cardiology. The log-log plot of the edge weight distribution appears to be linear in nature revealing a scale-free characteristic of the network while the distributions of node degree and node strength are less so. The analysis of the k-core network sizes under increasing removal of primary care nodes shows that about 10 most connected primary care nodes play a critical role in keeping the k-core networks connected because their removal .