Care coordination in epilepsy: Measuring neurologists' connectivity using social network analysis

Area of Science:

• Healthcare Management
• Neurology
• Health Services Research

Background:

• The Veterans Health Administration (VA) implemented an Epilepsy Center of Excellence (ECOE) model to improve epilepsy care coordination.
• Effective coordination between neurologists and other healthcare providers is crucial for managing epilepsy.
• Social network analysis (SNA) offers a quantitative method to assess care coordination.

Purpose of the Study:

• To quantify the changes in epilepsy care coordination over time.
• To compare care coordination across different VA facility types (ECOE hub, consortium, and unaffiliated sites).
• To evaluate the impact of the ECOE model on provider networks.

Main Methods:

• Social network analysis (SNA) was used to measure provider connectivity.
• Node degree, representing connections between neurologists and other providers based on shared patients, was calculated.
• Mixed models compared changes in facility-level node degree from 2000-2013 across three facility types, adjusting for provider numbers.

Main Results:

• Epilepsy care coordination, both within and across facilities, significantly increased between 2000 and 2013.
• This increase was observed across all three facility types (hub, consortium, unaffiliated) with similar magnitude.
• Connectivity gains were more pronounced for providers across facilities than within the same facility.

Conclusions:

• The VA's ECOE hub and spoke model contributed to enhanced epilepsy care coordination from 2000-2013.
• Significant variation in coordination improvements existed across facilities.
• SNA is a valuable tool for measuring specialty care coordination.