Identifying Hidden Relational Processes that Fragment Care for Older Adults with ADRD and Multimorbidity: A Social Network Analysis Approach
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Background: Care fragmentation is a major challenge for older adults living with Alzheimer's Disease and Related Dementias (ADRD) and multimorbidity. Those in this population who are adversely affected by social determinants of health (SDoH) are particularly vulnerable to the negative outcomes associated with care fragmentation due to complex care needs, cognitive impairments, and social barriers. Care fragmentation is associated with medical errors, poor patient experience, billions of dollars in wasteful healthcare spending, and increased mortality. Although care coordination can mitigate care fragmentation and reduce social barriers associated with disparities in health outcomes, it demands collective efforts and interdependent relationships by clinicians across care teams and sites. Care coordination research has primarily focused on care tasks or components and standardized tools. The complex, dynamic, and interdependent relationships among clinicians through which care is delivered and coordinated have not been sufficiently evaluated. Approach: Based on my previous work, I propose that this gap be addressed using social network analysis (SNA) and electronic health record (EHR) data. Use of SNA and EHR data may better evaluate system- and patient-level clinician networks across settings and over time (during K99) and explicate how clinician networks relate to patients’ social context and health outcomes (during R00) for older adults with ADRD and multimorbidity. Specific Aim 1 will map the system-level clinician network for a cohort of over 90,000 older adults with multimorbidity, including ADRD, using a combination of structured and unstructured EHR data. Specific Aim 2 will detect and describe patient-level clinician networks for older adults with ADRD and identify characteristics of weak networks that could be associated with fragmented care. Specific Aim 3 will identify relational processes that are influenced by SDoH and contribute to disparities in health outcomes for older adults with ADRD. I hypothesize that patients more adversely affected by individual- and community-level SDoH are more likely to be cared for by clinicians in peripheral system positions, fragmented network structures, or networks weakening over time, and that having peripheral, fragmented, or weakening clinician networks will be associated with higher costs and risks for hospitalization and mortality. Mentoring and Training Plan: I will work with a highly interdisciplinary mentorship team of experts in data science, complex systems, health disparities, bioinformatics, health services and outcomes, computational social science, stakeholder engagement, primary care, ADRD, and aging research. My mentorship team will guide my training to gain competencies in longitudinal SNA and natural language processing during the K99. This K99/R00 award is vital for continuing my progress in achieving my career goal of establishing an independent, transdisciplinary research program to improve care coordination, thereby enhancing healthcare quality for older adults with multimorbidity, particularly those living with ADRD.
