A framework for administrative claim data to explore healthcare coordination and collaboration

Abstract

Previous studies have documented the application of electronic health insurance claim data for health services research purposes. In addition to administrative and billing details of healthcare services, insurance data reveal important information regarding professional interactions and/or links that emerge among healthcare service providers through, for example, informal knowledge sharing. By using details of such professional interactions and social network analysis methods, the aim of the present study was to develop a research framework to explore health care coordination and collaboration. The proposed framework was used to analyse a patient-centric care coordination network and a physician collaboration network. The usefulness of this framework and its applications in exploring collaborative efforts of different healthcare professionals and service providers is discussed. What is known about the topic? Application of methods and measures of social network analytics in exploring different health care collaboration and coordination networks is a comparatively new research direction. It is apparent that no other study in the present healthcare literature proposes a generic framework for examining health care collaboration and coordination using an administrative claim dataset. What does this paper add? Using methods and measures of social network analytics, this paper proposes a generic framework for analysing various health care collaboration and coordination networks extracted from an administrative claim dataset. What are the implications for the practitioners? Healthcare managers or administrators can use the framework proposed in the present study to evaluate organisational functioning in terms of effective collaboration and coordination of care in their respective healthcare organisations.