Browsing by Subject "Social network analysis"

Effective patient care transitions require consideration of the patient’s social and clinical contexts, yet how these factors relate to the processes in care coordination remains poorly described. This dissertation aimed to describe provider networks and clinical care and social contexts involved during longitudinal care transitions across settings. The overall purpose of this dissertation is to uncover the longitudinal patterns of utilization and relational processes needed for effective care coordination in transitional care, so we can redesign interventions that focus on informational and relationship networks to improve interaction patterns and system performance for people living with heart failure (HF) as they undergo transitions across settings and over time. This dissertation was a retrospective exploratory study. Chapter 2 is an integrative review examining coordination processes in transitional care interventions for older adults with HF by integrating a social network analysis framework. We subsequently selected a cohort of patients aged 18 years or older (n = 1269) with an initial hospitalization for HF at Duke University Health System between January 1, 2016 and December 31, 2018 based on encounter, sociodemographic, and clinical data extracted from electronic health records (EHR). In Chapter 3, a latent growth trajectory analysis was used to identify distinct subgroups of patients based on the frequency of outpatient, as well as emergency department (ED) and inpatient encounters 1 year before and 1 year after the index hospitalization; multinomial logistic regression was then used to evaluate how outpatient utilization was related to acute care utilization. Based on findings (described in Chapter 3), we purposively sampled 11 patients from the Chapter 3 cohort for a second empirical study (described in Chapter 4) with a mixed-methods sequential explanatory design. These 11 patients had a full spectrum of experience in socioeconomic disadvantages based on three strata (race, insurance, and Area Deprivation Index), but they had similar levels of comorbidity and average severity of illness and displayed the same change in the severity of illness during the study period. We used quantitative and qualitative data available from clinical notes in the EHR, and integrated results from quantitative and qualitative analysis to better understand the social and clinical context and social structure essential for care coordination. High variability in transitional care is likely because care coordination processes are highly relational. The relational structure of transitional care interventions varied from triadic to complex network structures. Use of a network analysis framework helped to uncover relational structures and processes underlying transitional care to inform intervention development. Chapter 3 revealed that high heterogeneity exists in patients’ utilization patterns. A small subgroup of high users utilized a substantial amount of the resources. Patients with high outpatient utilization had more than 4 times the likelihood of also having high acute care utilization, and change in the severity of illness had the highest level of significance and strongest magnitude of effect on influencing high acute care utilization. Chapter 4 demonstrated the feasibility of using clinical notes and social network analysis (SNA) to assess the provider networks for patients with HF in care transitions. People who were experiencing more socioeconomic disadvantages and social instability were less likely to have densely connected provider teams and providers who were central and influential in the system network. Lacking consistent and reciprocal relationships with outpatient provider teams, especially primary care provider and cardiology teams, was precedent to poor care management and coordination. Turbulence in care transition can result from sources other than transitioning between settings. This dissertation demonstrated the (a) importance of understanding relational processes and structure during patients’ utilization of acute and outpatient care services and (b) potential to capture structural inequalities that may influence the efficiency of care coordination and health outcomes for patients with HF.

Adolescence is a key point in the life course, and friendships during this time are strong predictors of health and behavioral outcomes. This dissertation seeks to understand the causes and consequences of friendship stability, answering the question: Friendships during adolescence are important, but does it matter how long they last? Chapter Two introduces a new measure of friendship stability and tests possible pathways by which it affects extreme outcomes, threatening oneself or others. The findings indicate that some of these mechanisms partially explain this relationship, but low network instability remains strongly associated with the outcomes.Chapter Three examines the possible causes of friendship dissolution, as adolescents are more likely to dissolve the more unstable their networks. This chapter simultaneously tests individual, dyadic, and structural predictors of dissolution. The findings suggest that ego’s perception of intimacy, as well as the structural and dyadic features of the relationship, are the most prominent predictors of dissolution. Additionally, the results suggest differing relationships between several structural and dyadic features when considering whether friendship is reciprocated. Chapter four examines the relationship between racial peer mixing and mental health. I tested the effect of having cross-race ties on mental health, conditional on individuals being a racial minority in their school population. I also test whether two contextual factors of egos friendships, intimacy, and stability–mediate this relationship. I found that when adolescents are minorities in their schools, cross-race friendships somewhat protect them from emotional distress, and that this relationship is minimally mediated by friendship intimacy.

The UM-Flint Urban Alternatives House (UAH) is a LEED Platinum certified residential property redevelopment project established in 2010 through a partnership between the Genesee County Land Bank Authority and the University of Michigan-Flint. UM-Flint with community partners seek to use the UAH as demonstration project that connects residents in Flint and Genesee County to programs and resources that support adoption of sustainability measures to increase community resilience. Population decline and economic challenges are evident in the metropolitan Flint area, and energy costs place a larger financial burden on low income households. The desire to connect residents to resources that reduce residential energy and water costs while advancing adoption of sustainable practices informed development of this study.

The objectives of the study were to identify organizations and programs in Flint and Genesee County that provided resources or support to advance household level energy efficiency, water conservation, and sustainable development practices, to understand how these organizations are networked together, and to understand the opportunities and barriers they perceive relative to advancing efforts in the region. To meet this objective, the study focused on gathering organization level information and perspectives. Participants were identified using a snowball sampling technique.

Stakeholder analysis and social network analysis were the methods used to inform the study. The stakeholder analysis was completed using an integrated approach, informed by semi-structured interviews with nineteen stakeholders (n=19). NVivo 10 quantitative analysis software was employed to analyze stakeholder interview responses using a strategic perspectives approach. An actor linkage survey was completed by seventeen of the participants (n=17), and the information collected from the surveys provided data for the social network analysis completed using NetMiner10 software.

Forty-eight organizations were identified as stakeholders with direct or indirect alignment with the study area. Thirty-four of these organization were active in the study region. Analytical categorizations resulted in organizations being classified in three levels: type (i.e. Government, community organization, etc.), organizational alignment identified as 1) Community Economic Development, 2) Community Education and Engagement, 3) Health, and 4) Coordination/Collaboration, and study alignment identified as 1) Energy Efficiency, 2) Water Conservation, 3) Construction (Regular and “Green”), 4) Agriculture and Food Access, and 5) Recycling and Waste Management.

The first portion of the results section explores the themes found through analysis of the stakeholder interview data. The organizational alignments provided a broad context through which the themes emerged. Community economic development examines the role of stakeholders involved in housing programs, often supported by state and federal funding aimed at low to moderate income households. Community education and engagement highlights the important role of the utility provider as well as water quality and resources management organizations, and educational institutions. Health aligned stakeholders included those that addressed household hazards and organizations engaged in local food system work. Coordination and collaboration identifies that many partnerships exist, but only one local collaboration focused primarily on household health and sustainability. Opportunities and barriers are also examined.

The second portion of the results section features the results of the social network analysis. The social network analysis focuses on measures of centrality, exploring the properties of an actor (stakeholders represented as nodes in the network) and the prominence of said actor in the network based on the ties to other actors. Measures of centrality highlighted in the analysis include in- and out-degree centrality, closeness centrality, and betweenness centrality which are often positively correlated. The dominant actors and the deviations from the positive correlations found between the centrality measures are identified.

The discussion and recommendations section of the study notes that a variety of programs and initiatives exist that support energy efficiency, water conservation, sustainable construction, and overall household level sustainability in in the study region, but few stakeholders have a primary focus in these areas. Recommendations for ongoing stakeholder engagement with existing efforts and approaches to advance education and outreach objectives are made. The impacts of fluctuations in funding, particularly at the federal level, areas in which services are being centralized, and market gaps revealed by the study are discussed.

The study identifies several areas to advance residents’ connections to energy efficiency, water conservation, and household level sustainability, and concludes with the following:

• Education is both an opportunity and a barrier to connecting residents to resources for energy efficiency, water conservation, and household level sustainability. The inventory of programs may serve as a starting point to connecting residents to these resources, and development of a social marketing campaign could advance both promotion and adoption of these resources.
• Stakeholders in the Flint area are actively partnering on a number of initiatives and to advance community sustainability in a larger context. Building a shared understanding of household sustainability, understanding the strengths and limitations of partner organizations, and finding ways to creatively leverage resources through new and existing collaborations could support efforts moving forward.
• Ongoing engagement with stakeholders aligned with fair housing, natural resource management/water quality, and local food systems is recommended. The important role of government in connecting to resources and advancing a collective vision is recognized. Building alignments with business and economic development efforts is also suggested.

Research in organizational ecology demonstrates that an organization’s competitive position within its market is highly associated with its survival chances, and that patterns of competitive constraint among organizations influence how markets evolve. However, the literature’s conceptualization of market structure is relatively coarse and static; it does not explore how individual organizations’ competitive positions shift or how market offerings change over relatively short intervals of time. In this study, I use social network analysis to study the structure of organizations’ competitive relationships directly. I examine both how changes in the structure of an organization’s competitive environment influence its survival chances, and how the structure of organizations’ competitive relationships affect the stability of market offerings. With a combination of a large crowd-sourced restaurant dataset from Yelp.com and census tract information from the American Community Survey (Census Bureau, 2009; Yelp, 2019), I apply methods from social network analysis, text analysis, and geographic information systems to track how restaurants’ competitive relationships change over time and space, and to study how these changes influence restaurants’ survival chances and overall market stability. This study provides evidence for new mechanisms of competitive constraint among organizations (niche centrality and niche compression) and new mechanisms of market stability (niche redundancy), offers a new theoretic framework for studying market structure and organizational evolution, and has critical implications for theory in the field of organizational ecology.

Gender and racial stereotypes are a pervasive aspect of social life arising from the consolidation of resources, statuses, and social roles and identities at the population level. They are widely shared group-level associations that influence how we perceive ourselves and others. Understanding how stereotypes influence the impressions we form about others, however, requires understanding how the association between statuses such as gender or race and the other identities we occupy influences impressions. This dissertation examines this process in three studies. In Studies 1 and 2, I model how people react to events using affect control theory’s impression change methodology. I estimate models using event stimuli collected in 1978 and 2010. I find that stereotypically female and male identities have affective profiles that influence how we form impressions. Affect control theory is best able to explain events involving identities that respondents perceived as associated with both genders. Study 3 analyzes perceptions of aggression among adolescents using longitudinal network data. I find (1) that the association between aggression and race grew as Black friend groups grew more homogeneous, (2) that both Black and White students held racialized status meanings, (3) that within-group similarities and between-group differences with respect to perceptions and behaviors grew over time, and (4) that Blacks were more likely to be identified as aggressive after controlling for self-perceptions of aggressiveness, violent behaviors, and peer perceptions of relational and social aggression. Combined, these studies suggest that the association between cultural meanings of goodness, potency, and aggression and statuses such as gender and race are mediated by identities.