Understanding Utilization of Diabetes Self-Management Education and Support Using Social Network Analysis - PROJECT SUMMARY Diabetes Self-Management Education and Support (DSMES) addresses the clinical, psychological, and behavioral aspects of care needed to successfully self-manage diabetes. Despite the proven value of the DSMES on patient outcomes, it remains underutilized. Only a small fraction of patients receive DSMES within a year of being diagnosed with diabetes: 5% of those with Medicare and 6.8% of those with private insurance. While the causes of low enrollment in DSMES are systemic and patient- and provider-based, the role of the system-level factors, especially collaboration among providers, in DSMES utilization is not fully understood. Since providers have a significant impact on whether patients attend DSMES, it is essential to understand the practice patterns of providers regarding DSMES utilization. This K25 fills this gap in knowledge by using 2 theoretical concepts—diffusion of innovations and social network analysis—to determine whether patient-sharing relationships among the providers who care for patients with T2D is associated with DSMES utilization. Aim 1 leverages health insurance claims for Medicare, Medicare Advantage and privately insured patients to examine DSMES participation in Arkansas at the patient level. Aim 2 will construct a multilevel network model comprising patients, providers, and a patient-sharing network of T2D providers. The network, created using health insurance claims data, connects pairs of providers if they both deliver care to the same patient. A multilevel statistical method, auto-logistics actor attribute models will examine whether the social network structure of providers caring for T2D patients is associated with DSMES utilization. This project will utilize membership, medical claims, and provider data for Medicare and Medicare Advantage enrollees (65 years old and above) and privately insured enrollees (aged 18 and above) from 2013–2020 from the Arkansas All-Payer Claims Database. The principles of innovation diffusion suggest that the rate of diffusion of the adoption depends on influential members of the social system (i.e., opinion leaders) adopting an innovation and their decision being communicated to other members, who then follow their lead. Aim 3 examines the feasibility of identifying opinion leaders through the use of self-designating survey instruments, providing a foundation that can potentially be utilized to enhance DSMES uptake among providers. These aims will serve as a system-science methodological approach to understand DSMES utilization given patient and provider characteristics and patient-sharing relationship among providers. Understanding the network structure of T2D providers will facilitate the identification of network intervention strategies to promote DSMES referral behavior among providers. This K25 will provide the investigator with foundational training in network science and diffusion of innovations and is aligned with her long-term career goal of becoming a productive independent researcher in designing network interventions to improve diabetes care.
