OBJECTIVE:The study sought to quantify coordination of epilepsy care, over time, between neurologists and other health care providers using social network analysis (SNA). METHODS:The Veterans Health Administration (VA) instituted an Epilepsy Center of Excellence (ECOE) model in 2008 to enhance care coordination between neurologists and other health care providers. Provider networks in the 16 VA ECOE facilities (hub sites) were compared to a subset of 33 VA facilities formally affiliated (consortium sites) and 14 unaffiliated VA facilities. The number of connections between neurologists and each provider (node degree) was measured by shared epilepsy patients and tallied to generate estimates at the facility level separately within and across facilities. Mixed models were used to compare change of facility-level node degree over time across the three facility types, adjusted for number of providers per facility. RESULTS:Over the time period 2000-2013, epilepsy care coordination both within and across facilities significantly increased. These increases were seen in all three types of facilities namely hub, consortium, and unaffiliated site, relatively equally. The increase in connectivity was more dramatic with providers across facilities compared to providers within the same facilities. CONCLUSION:Establishment of the ECOE hub and spoke model contributed to an increase in epilepsy care coordination both within and across facilities from 2000 to 2013, but there was substantial variation across different facilities. SNA is a tool that may help measure coordination of specialty care.

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目的:本研究试图通过社交网络分析(SNA)量化神经科医师与其他医疗保健提供者之间随着时间的推移癫痫治疗的协调性。
方法:退伍军人卫生管理局(VA)在2008年建立了癫痫病卓越中心(ECOE)模型,以加强神经科医生与其他卫生保健提供者之间的护理协调。将16个VA ECOE设施(集线器站点)中的提供商网络与33个正式关联的VA设施(财团站点)和14个未关联的VA设施的子集进行了比较。由共享的癫痫患者测量神经科医师与每个提供者之间的联系数(节点度),并计算以在设施级别内部和设施之间分别在设施级别生成估计值。混合模型用于比较三种设施类型上设施级别节点度随时间的变化,并针对每个设施的提供者数量进行了调整。
结果:在2000年至2013年期间,设施内和设施间的癫痫护理协调性显着提高。这些增加在三种类型的设施中都可以看到,即枢纽,财团和非附属场所,相对均等。与同一设施内的提供商相比,跨设施的提供商的连接性增长更为显着。
结论:从2000年到2013年,建立ECOE枢纽和轮辐模型有助于增加设施内和设施之间的癫痫护理协调,但不同设施之间存在很大差异。 SNA是一种工具,可以帮助评估专科护理的协调性。

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