Assessing the Association Between Network-based Provider Communities and Patient Mortality in the Medicare Population with Multiple Chronic Conditions.

Understanding the complexity of care delivery and care coordination for patients with multiple chronic conditions is challenging. Network analysis can model the relationship between providers and patients to find factors associated with patient mortality. We constructed a network by connecting the providers through shared patients, which was then partitioned into tightly connected communities using a community detection algorithm. After adjusting for patient characteristics, the odds ratio of death for one standard deviation increase in degree centrality ratio between primary care providers (PCPs) and non-PCPs was 0.95 (0.92-0.98). Our result suggest that the centrality of PCPs may be a modifiable factor for improving care delivery. We demonstrated that network analysis can be used to find higher order features associated with health outcomes in addition to patient-level features.

Hierarchical patient-centric caregiver network method for clinical outcomes study.

In clinical outcome studies, analysis has traditionally been performed using patient-level factors, with minor attention given to provider-level features. However, the nature of care coordination and collaboration between caregivers (providers) may also be important in determining patient outcomes. Using data from patients admitted to intensive care units at a large tertiary care hospital, we modeled the caregivers that provided medical service to a specific patient as patient-centric subnetwork embedded within larger caregiver networks of the institute. The caregiver networks were composed of caregivers who treated either a cohort of patients with particular disease or any patient regardless of disease. Our model can generate patient-specific caregiver network features at multiple levels, and we demonstrate that these multilevel network features, in addition to patient-level features, are significant predictors of length of hospital stay and in-hospital mortality.

Correction: The Impact of Heterogeneous Thresholds on Social Contagion with Multiple Initiators.

[This corrects the article DOI: 10.1371/journal.pone.0143020.].

The Impact of Heterogeneous Thresholds on Social Contagion with Multiple Initiators.

The threshold model is a simple but classic model of contagion spreading in complex social systems. To capture the complex nature of social influencing we investigate numerically and analytically the transition in the behavior of threshold-limited cascades in the presence of multiple initiators as the distribution of thresholds is varied between the two extreme cases of identical thresholds and a uniform distribution. We accomplish this by employing a truncated normal distribution of the nodes' thresholds and observe a non-monotonic change in the cascade size as we vary the standard deviation. Further, for a sufficiently large spread in the threshold distribution, the tipping-point behavior of the social influencing process disappears and is replaced by a smooth crossover governed by the size of initiator set. We demonstrate that for a given size of the initiator set, there is a specific variance of the threshold distribution for which an opinion spreads optimally. Furthermore, in the case of synthetic graphs we show that the spread asymptotically becomes independent of the system size, and that global cascades can arise just by the addition of a single node to the initiator set.