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Exploring the use of social network analysis in identifying physician engagement in quality improvement in the hospital setting.

机译：探索社交网络分析在确定医生参与医院环境质量改善中的用途。

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摘要

Physicians are an integral component in the performance of clinical process of care and patient experience measures in the hospital setting. A deeper understanding of physician influence in quality improvement by hospital leaders will be key to a hospital's success in the various programs set into motion by the Affordable Care Act (ACA) of 2010. The law, intended to put into place health insurance reforms, has an implementation timeline of four years and beyond. Many healthcare leaders across the country have been preparing for the changes in the way of services, programs, and incentives which are intended to improve quality and lower costs. One such program is the Centers for Medicare & Medicaid Services (CMS) Hospital Value Based Purchasing (VBP) program. This pay for performance program differentiates hospital inpatient payment rates based on performance in process, outcome, and patient satisfaction measures. Beginning in 2013, 1% of a hospitals inpatient Medicare payment is at risk with a 0.25% increase each year thereafter, capping at 2% in 2017. The program holds providers accountable for their success or improvement in clinical process of care and patient experience measures via a withhold/payback structure.;This research sought to explore the use of social network analysis (SNA) in identifying physician engagement in quality improvement in a hospital setting. The study involved SNA in determining level of physician prominence within a defined network to answer the following research questions: 1) How can healthcare leaders identify physicians within their organization as quality improvement "champions" in order to increase the effectiveness of their group in modeling and/or disseminating behavior change within a hospital to improve the overall quality of care outcomes? 2) How do self-perspectives on physician knowledge regarding CMS quality core measures align with other physician's perspectives on seeking out that physician's input on quality? The objective of the study was to map the relationships and communications of a network of physicians in a 265 acute care bed hospital as a means of evaluating influential discussions surrounding quality improvement initiatives. Analysis was performed and physician prominence within the network was identified and quantified mathematically by defining centrality by degree, closeness, and betweenness. Statistical inferences could not be made from the additional level of analysis in determining if relationships existed between the variables of specialty, years of service, and familiarity with CMS core measures and the VBP program. The utilization of SNA in this study provided valuable empirical information that can be utilized by healthcare leaders in identifying physician quality improvement "champions" within their organizations. The information serves as a valuable tool in assisting healthcare leaders in strategizing their approach to improve the overall quality outcomes in their organization by ensuring a more effective and engaged physician network. Future action research is recommended to identify whether or not clinical quality outcomes improve as a result of identifying physician "champions" based on network information. Physician involvement in quality improvement initiatives will be crucial to the success of hospitals in CMS at risk programs such as the VBP program and can position an organization for a more financially stable future and a sustainable culture of quality.
机译：医师是医院环境中临床护理过程和患者体验措施不可或缺的组成部分。医院领导者对医师对改善质量的影响的深入了解，将是医院成功实施2010年《可负担医疗法案》（ACA）所实施的各项计划的关键。该法律旨在实施医疗保险改革，四年以上的实施时间表。全国各地的许多医疗保健领导者一直在为服务，计划和激励方式的变革做准备，这些变革旨在提高质量和降低成本。一种这样的计划是医疗保险和医疗补助服务中心（CMS）医院基于价值的购买（VBP）计划。该绩效工资计划根据过程绩效，结果和患者满意度指标来区分医院住院患者的支付率。从2013年开始，医院住院医疗保险费用的1％处于风险之中，此后每年以0.25％的速度递增，2017年上限为2％。该计划要求医疗服务提供者对他们在临床护理过程中的成功或改善以及患者体验措施负责通过预扣/还款结构。该研究试图探索社交网络分析（SNA）在确定医生参与医院质量改善方面的用途。这项研究涉及SNA来确定已定义网络中医师的突出水平，以回答以下研究问题：1）医疗保健领导者如何将其组织内的医师识别为质量改善的“冠军”，以提高其团队在建模和建模方面的有效性。 /或在医院内传播行为改变以改善总体护理质量？ 2）关于医师关于CMS质量核心指标的知识的自我看法如何与其他医师在​​寻求医师对质量的意见时的观点相一致？这项研究的目的是绘制265家急诊病床医院内医生网络的关系和交流情况，以此作为评估围绕质量改进计划的有影响力的讨论的一种手段。通过定义程度，亲密性和中间性的中心性，进行了分析，并通过数学方法确定并量化了网络中医师的突出地位。在确定专业变量，服务年限以及对CMS核心指标和VBP程序的熟悉程度之间是否存在关系时，无法从其他分析级别进行统计推断。在这项研究中SNA的利用提供了宝贵的经验信息，医疗保健领导者可以利用这些经验信息来确定其组织内的医师质量改善“冠军”。该信息是帮助医疗保健领导者制定策略以通过确保更有效和更富参与性的医生网络来改善其组织的总体质量结果的宝贵工具。建议进行未来的行动研究，以根据网络信息确定医生的“冠军”，从而确定临床质量结果是否得到改善。医师参与质量改进计划对于CMS风险计划（例如VBP计划）中的医院成功与否至关重要，并且可以使组织在财务上更稳定的未来和可持续的质量文化中定位。

著录项

  • 作者

    Wagner, Kay M.;

  • 作者单位

    Central Michigan University.;

  • 授予单位 Central Michigan University.;
  • 学科 Sociology Theory and Methods.;Health Sciences Health Care Management.;Sociology Organization Theory.
  • 学位 D.H.A.
  • 年度 2013
  • 页码 132 p.
  • 总页数 132
  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类
  • 关键词

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