  OBJECTIVE: To test the hypothesis that variation in care coordination is
related to LOS. DESIGN We applied a spectral co-clustering methodology to
simultaneously infer groups of patients and care coordination patterns, in the
form of interaction networks of health care professionals, from electronic
medical record (EMR) utilization data. The care coordination pattern for each
patient group was represented by standard social network characteristics and
its relationship with hospital LOS was assessed via a negative binomial
regression with a 95% confidence interval. SETTING AND PATIENTS This study
focuses on 5,588 adult patients hospitalized for trauma at the Vanderbilt
University Medical Center. The EMRs were accessed by healthcare professionals
from 179 operational areas during 158,467 operational actions. MAIN OUTCOME
MEASURES: Hospital LOS for trauma inpatients, as an indicator of care
coordination efficiency. RESULTS: Three general types of care coordination
patterns were discovered, each of which was affiliated with a specific patient
group. The first patient group exhibited the shortest hospital LOS and was
managed by a care coordination pattern that involved the smallest number of
operational areas (102 areas, as opposed to 125 and 138 for the other patient
groups), but exhibited the largest number of collaborations between operational
areas (e.g., an average of 27.1 connections per operational area compared to
22.5 and 23.3 for the other two groups). The hospital LOS for the second and
third patient groups was 14 hours (P = 0.024) and 10 hours (P = 0.042) longer
than the first patient group, respectively.
