title: Provider Patient-Sharing Networks and Multiple-Provider Prescribing of Benzodiazepines.
abstract: BACKGROUND
  Prescription benzodiazepine overdose continues to cause significant morbidity and mortality in the US. Multiple-provider prescribing, due to either fragmented care or "doctor-shopping," contributes to the problem.
  
  
  OBJECTIVE
  To elucidate the effect of provider professional relationships on multiple-provider prescribing of benzodiazepines, using social network analytics.
  
  
  METHODS
  A retrospective analysis of commercial healthcare claims spanning the years 2008 through 2011. Provider patient-sharing networks were modelled using social network analytics. Care team cohesion was measured using care density, defined as the ratio between the total number of patients shared by provider pairs within a patient's care team and the total number of provider pairs in the care team. Relationships within provider pairs were further quantified using a range of network metrics, including the number and proportion of patients or collaborators shared.
  
  
  METHODS
  The relationship between patient-sharing network metrics and the likelihood of multiple prescribing of benzodiazepines.
  
  
  METHODS
  Patients between the ages of 18 and 64 years who received two or more benzodiazepine prescriptions from multiple providers, with overlapping coverage of more than 14 days.
  
  
  RESULTS
  A total of 5659 patients and 1448 provider pairs were included in our study. Among these, 1028 patients (18.2 %) received multiple prescriptions of benzodiazepines, involving 445 provider pairs (30.7 %). Patients whose providers rarely shared patients had a higher risk of being prescribed overlapping benzodiazepines; the median care density was 8.1 for patients who were prescribed overlapping benzodiazepines and 10.1 for those who were not (p < 0.0001). Provider pairs who shared a greater number of patients and collaborators were less likely to co-prescribe overlapping benzodiazepines.
  
  
  CONCLUSIONS
  Our findings demonstrate the importance of care team cohesion in addressing multiple-provider prescribing of controlled substances. Furthermore, we illustrate the potential of the provider network as a surveillance tool to detect and prevent adverse events that could arise due to fragmentation of care.
authors.affiliation: Children's Hospital Informatics Program, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA.|Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, 2109, Australia.
authors.forename: Mei-Sing
authors.initials: MS
authors.lastname: Ong
authors.affiliation: Children's Hospital Informatics Program, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA.|Department of Pediatrics, Harvard Medical School, Boston, MA, 02115, USA.
authors.forename: Karen L
authors.initials: KL
authors.lastname: Olson
authors.affiliation: Children's Hospital Informatics Program, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA.|Department of Pediatrics, Harvard Medical School, Boston, MA, 02115, USA.
authors.forename: Aurel
authors.initials: A
authors.lastname: Cami
authors.affiliation: Center for Biomedical Informatics, Harvard Medical School, Boston, MA, 02115, USA.
authors.forename: Chunfu
authors.initials: C
authors.lastname: Liu
authors.affiliation: Center for Biomedical Informatics, Harvard Medical School, Boston, MA, 02115, USA.
authors.forename: Fang
authors.initials: F
authors.lastname: Tian
authors.affiliation: Center for Biomedical Informatics, Harvard Medical School, Boston, MA, 02115, USA.
authors.forename: Nandini
authors.initials: N
authors.lastname: Selvam
authors.affiliation: Children's Hospital Informatics Program, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA. Kenneth_Mandl@harvard.edu.|Department of Pediatrics, Harvard Medical School, Boston, MA, 02115, USA. Kenneth_Mandl@harvard.edu.|HealthCore, Inc, Alexandria, VA, USA. Kenneth_Mandl@harvard.edu.
authors.forename: Kenneth D
authors.initials: KD
authors.lastname: Mandl
mesh_terms: D000293:Adolescent; D000328:Adult; D001569:Benzodiazepines / Q000008:administration & dosage*; D061891:Controlled Substances / Q000008:administration & dosage; D016208:Databases, Factual; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D057970:Inappropriate Prescribing / Q000517:prevention & control / Q000706:statistics & numerical data*; D007400:Interprofessional Relations; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team / Q000458:organization & administration / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D000067490:Prescription Drug Overuse / Q000517:prevention & control / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012944:Social Support; D014481:United States; D055815:Young Adult
chemical_list: D061891:Controlled Substances; D001569:Benzodiazepines
keywords: drug overdose; prescribing patterns; social networks