Abstract 15030: Hidden Sources of Inequity in Heart Failure Care Transitions: A Mixed-Method Network Analysis of Clinical Notes

Abstract

Introduction: Fragmentation in heart failure (HF) care transitions occur disproportionately among those adversely affected by social drivers of health. Social network analysis (SNA) may provide new insights into barriers to equitable care. Purpose: To assess the nature and structure of clinician networks across health system settings of care during care transitions. Methods: An explanatory sequential mixed-methods design was used. We stratified a purposeful sample (n=11) from a cohort of adults (n=1269) first hospitalized for HF between 2016 and 2018 by race, Medicaid use, and Area Deprivation Index, adjusting for risk (3M Clinical Risk Groups Severity of Illness Score and Charlson Comorbidity Index). EHR clinical notes were used to construct patients' clinician networks 1-year before, during, and after the index hospitalization using patient-sharing (2-mode) SNA. Patients' clinician positional and structural network measures were integrated with qualitative analyses of clinical notes. Results: Socioeconomically advantaged patients used fewer acute care services and lived longer. They tended to have higher network density and clinicians more centrally located in the health system network earlier and across settings and frequent telephone notes between visits that indicated reciprocal communication patterns among patients and clinicians shown in contents. Close care relationships and early involvement of influential providers measured by high Eigenvector centrality may be vital for smooth care transitions. Conclusions: Barriers to care coordination may result from variability in clinician networks. Well-connected clinician teams and consistent and reciprocal communication between patients and outpatient care teams are associated with more effective care coordination. Patients with clinicians in central and bridge positions within a health system network may receive higher quality care due to greater social capital and influence.