UC Berkeley

This dissertation explores the dynamics of patient engagement and clinical collaboration within the framework of patient-centered care, following a four-paper format. The research is divided into two main themes: the application of decision aids to enhance shared decision-making in breast cancer screening, and the examination of clinician networks to improve care coordination for Federally Qualified Health Center (FQHC) patients with chronic diseases.

Paper 1 examines physician practices’ adoption of decision aids for breast cancer screening. Findings suggest that practices with limited health information technology, higher barriers to innovation adoption, and larger or system-owned organizational structures face significant challenges in widespread decision aid adoption. Paper 2 then assesses the association between decision aid use and mammography uptake among older women, highlighting that despite the potential for decision aids to improve patient-provider communication and informed decision-making, inconsistent implementation limits their observed impact on mammography rates.

Paper 3 investigates the restructuring of patient-sharing clinician networks in FQHCs during the COVID-19 pandemic, revealing increases in overall network dispersion. This study emphasizes the need for adaptive care coordination strategies that leverage network structures to enhance collaborative dynamics during public health crises. Paper 4 builds upon this work by focusing on the role of clinician network brokerage in managing chronic conditions within FQHCs. While brokerage showed no significant association with blood pressure outcomes, it was correlated with improved diabetes management, suggesting that structural network characteristics may have potential implications for chronic disease outcomes in FQHC settings.

Overall, this dissertation underscores the necessity of integrating patient-centered tools like decision aids into clinical practice and utilizing network analysis to inform and optimize healthcare delivery and policy in complex care settings. Future research should continue to explore these approaches to further enhance engagement and collaboration, ultimately improving health outcomes in diverse patient populations.