Analysis of the U.S. patient referral network

Stat Med. 2018 Feb 28;37(5):847-866. doi: 10.1002/sim.7565. Epub 2017 Dec 4.

Abstract

In this paper, we analyze the US Patient Referral Network (also called the Shared Patient Network) and various subnetworks for the years 2009 to 2015. In these networks, two physicians are linked if a patient encounters both of them within a specified time interval, according to the data made available by the Centers for Medicare and Medicaid Services. We find power law distributions on most state-level data as well as a core-periphery structure. On a national and state level, we discover a so-called small-world structure as well as a "gravity law" of the type found in some large-scale economic networks. Some physicians play the role of hubs for interstate referral. Strong correlations between certain network statistics with health care system statistics at both the state and national levels are discovered. The patterns in the referral network evinced using several statistical analyses involving key metrics derived from the network illustrate the potential for using network analysis to provide new insights into the health care system and opportunities or mechanisms for catalyzing improvements.

Keywords: generative model; hierarchical modeling; network science; physician network; shared patient network; social network analysis.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Algorithms*
  • Centers for Medicare and Medicaid Services, U.S.
  • Cluster Analysis
  • Computer Simulation
  • Databases, Factual
  • Humans
  • Medical Record Linkage*
  • Physicians
  • Practice Patterns, Physicians' / statistics & numerical data*
  • Referral and Consultation*
  • United States