Regional medical inter-institutional cooperation in medical provider network constructed using patient claims data from Japan

Yu Ohki; Yuichi Ikeda; Susumu Kunisawa; Yuichi Imanaka

doi:10.1371/journal.pone.0266211

Peer Review History

Original SubmissionMarch 21, 2022
27 Jun 2022 Decision Letter - Hocine Cherifi, Editor PONE-D-22-07692Regional medical inter-institutional cooperation in medical provider network constructed using patient claims data from JapanPLOS ONE Dear Dr. Ohki, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Please submit your revised manuscript by Aug 11 2022 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. 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The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf 2. In your Data Availability statement, you have not specified where the minimal data set underlying the results described in your manuscript can be found. PLOS defines a study's minimal data set as the underlying data used to reach the conclusions drawn in the manuscript and any additional data required to replicate the reported study findings in their entirety. All PLOS journals require that the minimal data set be made fully available. For more information about our data policy, please see http://journals.plos.org/plosone/s/data-availability. 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We will update your Data Availability statement to reflect the information you provide in your cover letter. 3. Thank you for stating the following financial disclosure: “This work was supported by JSPS KAKENHI (Grant Number: JP19H01075) from the Japan Society for the Promotion of Science and Health and Labour Sciences Research Grant from the Ministry of Health, Labour and Welfare, Japan (Grant Number: 21IA1005 and 21FA1012). YO thanks the Kyoto University Science and Technology Innovation Creation Fellowship. Y. Ikeda and YO would also like to acknowledge Ripple, which is providing financial support through its University Blockchain Research Initiative.” Please state what role the funders took in the study. If the funders had no role, please state: "The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript." If this statement is not correct you must amend it as needed. Please include this amended Role of Funder statement in your cover letter; we will change the online submission form on your behalf. 4. Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. Additional Editor Comments : This paper studies medical cooperation efficiency through medical provider and physician networks based on patient claim data. They are starting with a bipartite network of a patient using medical providers. They build the projected networks. They extract network features to predict the quality of healthcare. They computed the duration of hospital stay of patients in each case of surgery related to the femoral neck 633 fracture. They also use community structure analysis to investigate the relationship between the level of medical cooperation and network structure. They show that the regional medical inter-institutional collaboration represented by the medical provider network is an essential factor in shortening the duration of hospital stay. The paper is well written. Experiments and results are sound. The methodology and the findings are of great interest to the scientific community. Therefore, I recommend publication after taking care of the minor revisions suggested by the reviewer. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes ****** 3. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes ****** 5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: Overall, this paper is excellent. This paper uses standard network science notations and so is generally easy to read and figure out. The work is strong, and the results are quite interesting. I have only small comments, listed below. Abstract: In the abstract and intro you mention 4 types of models. It would be useful to simply list the 4 types, maybe even as 1, 2, 3, 4, like what you did with the study focus. Or something like: “Models 1 and 2 use node strength and linear regression, with Model 2 also incorporating patient age as an input. Models 3 and 4 use feature representation by node2vec with linear regression and regression tree ensemble, a machine learning method.” Also, in both abstract and intro you use the word “strength” (or a “stronger medical provider”) to describe medical providers, and it is not totally clear what it means in that context (it hasn’t been defined yet – l assume you mean it as defined on line 170). It might be better to say “The results showed that medical providers with higher levels of cooperation reduce the duration of hospital stay.” (as you do on lines 414-415) Introduction: Very small language errors. For example in the first paragraph, “establish healthcare systems” and “services to address this situation.” The organization section is confusion, referring to “section 2,” although the sections aren’t numbered. Line 108: “recovery phase hospitals” Line 125: “the following function” Data and Methods: I like the fact that you have used cosine similarity to normalize size of providers. Line 181: Might be useful to define assortativity. Line 233: This is my favorite paragraph in the paper. You have done an excellent job of explaining things. Overall I find this section to be well done. Good job. Results Line 399 Din is typeset wrong. Line 492 talks about 7 communities, but table 6 only shows 6. Discussion Line 522 I don’t think the models need to be repeated. This section is very well done. Summary This section is highly repetitive, and you have already said the important things in the discussion. I don’t think you need the second paragraph at all, and the 3rd paragraph is mostly repetition. ****** 6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No ******** [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0266211.r001
Revision 1
19 Jul 2022 Author Response Response to Reviewers 2022/07/12 We would like to thank the reviewers for their helpful comments. After serious consideration of all the comments, the paper has been revised as follows. Revision Abstract: In the abstract and intro you mention 4 types of models. It would be useful to simply list the 4 types, maybe even as 1, 2, 3, 4, like what you did with the study focus. Or something like: “Models 1 and 2 use node strength and linear regression, with Model 2 also incorporating patient age as an input. Models 3 and 4 use feature representation by node2vec with linear regression and regression tree ensemble, a machine learning method.” Response to the comment: We described the four models we focused on in this research following your suggestion: "We considered four types of models. Models 1 and 2 use node strength and linear regression, with Model 2 also incorporating patient age as an input. Models 3 and 4 use feature representation by node2vec with linear regression and regression tree ensemble, a machine learning method." Also, in both abstract and intro you use the word “strength” (or a “stronger medical provider”) to describe medical providers, and it is not totally clear what it means in that context (it hasn’t been defined yet – l assume you mean it as defined on line 170). It might be better to say “The results showed that medical providers with higher levels of cooperation reduce the duration of hospital stay.” (as you do on lines 414-415) Response to the comment: We changed the sentence following your suggestions: "The results showed that medical providers with higher levels of cooperation reduce the duration of hospital stay.” Introduction: Very small language errors. For example in the first paragraph, “establish healthcare systems” and “services to address this situation.” Response to the comment: We changed the sentence to "establish healthcare systems" and "services to address this situation." The organization section is confusion, referring to “section 2,” although the sections aren’t numbered. Response to the comment: We changed the paragraph to "The remainder of this paper is organized as follows. The following section describes the role of medical cooperation among healthcare providers for a femoral neck fracture. We then describe the data, data analysis method, statistical model, and community analysis in the "Data and Method" section. The "Results" section presents the relationship between the features of medical providers and the duration of hospital stay based on the constructed network. Using a community analysis, we also examine the relationship between the network structure and medical cooperation. The "Discussion" section discusses the results, and the "Summary" section summarizes and concludes this paper." Line 108: “recovery phase hospitals” Response to the comment: We changed the sentence to "recovery phase hospitals." Line 125: “the following function” Response to the comment: We used the term "functional" because each component of Eq. (1) is a function and f represents a higher-order function. Thus, "the following functional" is correct. Data and Methods: I like the fact that you have used cosine similarity to normalize size of providers. Line 181: Might be useful to define assortativity. Response to the comment: We changed the sentence to "Assortativity r is the Pearson correlation coefficient of the degree of the nodes at both ends of the edge, r=Σ_ij (k_i k_j-〈k〉^2)/〖Σ_i (k_i-〈k〉)〗^2." Line 233: This is my favorite paragraph in the paper. You have done an excellent job of explaining things. Overall I find this section to be well done. Good job. Results Line 399 Din is typeset wrong. Response to the comment: We revised it to "D^in." Line 492 talks about 7 communities, but table 6 only shows 6. Response to the comment: We revised table 6 to add a "Community 7" column. Discussion Line 522 I don’t think the models need to be repeated. Response to the comment: We removed line 522 to line 531. This section is very well done. Summary This section is highly repetitive, and you have already said the important things in the discussion. I don’t think you need the second paragraph at all, and the 3rd paragraph is mostly repetition. Response to the comment: We removed the 2nd paragraph. We merged the 3rd paragraph and 4th paragraph: " We conclude that the regional medical inter-institutional cooperation represented by the medical provider network is an important factor in shortening the duration of hospital stay. We examined a model that uses the node2vec feature representation as input variables and ensemble learning as a regression model to improve the explanatory ability and found that the overall contribution of medical inter-institutional cooperation to the quality of healthcare provision at case level was approximately 20%. Other factors, such as the patient condition and care by the individual hospital, explained the remaining variation in the quality of healthcare. Medical inter-institutional cooperation still plays a significant role in providing high-quality healthcare. In addition, the results for community analysis suggested that the horizontally distributed network structure is effective for medical inter-institutional cooperation." https://doi.org/10.1371/journal.pone.0266211.r002
3 Aug 2022 Decision Letter - Hocine Cherifi, Editor Regional medical inter-institutional cooperation in medical provider network constructed using patient claims data from Japan PONE-D-22-07692R1 Dear Dr. Ohki, We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org. If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. Kind regards, Hocine Cherifi Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: https://doi.org/10.1371/journal.pone.0266211.r003
Formally Accepted
12 Aug 2022 Acceptance Letter - Hocine Cherifi, Editor PONE-D-22-07692R1 Regional medical inter-institutional cooperation in medical provider network constructed using patient claims data from Japan Dear Dr. Ohki: I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department. If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org. If we can help with anything else, please email us at plosone@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Professor Hocine Cherifi Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0266211.r004

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