Graph Neural Network for Predicting Fragmented Care Episodes Using Provider Networks, Encounter Sequences, Referral Patterns, Cross-Setting Utilization, and Unresolved Care Gap Indicators

cirpublications.com-gFTM-1790880680-f395662833 1790880680 Clinical Intelligence Research Press info@cirpublications.com Clinical Intelligence Research Press Journal of Health Informatics and Digital Systems J. Health Inform. Digit. Syst. 3149-8973 2025 5 2 Graph Neural Network for Predicting Fragmented Care Episodes Using Provider Networks, Encounter Sequences, Referral Patterns, Cross-Setting Utilization, and Unresolved Care Gap Indicators Patrick O’Connor Sean Murphy 2025 10.68159/f395662833 https://cirpublications.com/pub/journal/2/article/f395662833 Kern LM, Bynum JP, Pincus HA. Care fragmentation, care continuity, and care coordination—how they differ and why it matters. JAMA Intern Med. 2024;184(3):236-7. Kern LM, Ringel JB, Rajan M, Colantonio LD, Casalino LP, Pinheiro LC, et al. Ambulatory care fragmentation and subsequent hospitalization: evidence from the REGARDS study. Med Care. 2021;59(4):334-40. Edwards ST, Greene L, Chaudhary C, Boothroyd D, Kinosian B, Zulman DM. Outpatient care fragmentation and acute care utilization in veterans affairs home-based primary care. JAMA Netw Open. 2022;5(9):e2230036. Joo JY. Fragmented care and chronic illness patient outcomes: a systematic review. Nurs Open. 2023;10(6):3460-73. Funk RJ, Pagani FD, Hou H, Zhang M, Yang G, Malani PN, et al. Care fragmentation predicts 90-day durable ventricular assist device outcomes. Am J Manag Care. 2022;28(12):e444-e450. Kern LM, Seirup JK, Rajan M, Jawahar R, Miranda Y, Stuard SS. Extent of health care fragmentation in different payer populations: evidence from the Hudson Valley of New York. Popul Health Manag. 2019;22(2):138-43. Kern LM, Ringel JB, Rajan M, Casalino LP, Colantonio LD, Pinheiro LC, et al. Ambulatory care fragmentation, emergency department visits, and race: a nationwide cohort study in the US. J Gen Intern Med. 2023;38(4):873-80. Solares JR, Raimondi FE, Zhu Y, Rahimian F, Canoy D, Tran J, et al. Deep learning for electronic health records: a comparative review of multiple deep neural architectures. J Biomed Inform. 2020;101:103337. Ashfaq A, Sant'Anna A, Lingman M, Nowaczyk S. Readmission prediction using deep learning on electronic health records. J Biomed Inform. 2019;97:103256. Munoz-Gama J, Martin N, Fernandez-Llatas C, Johnson OA, Sepúlveda M, Helm E, et al. Process mining for healthcare: characteristics and challenges. J Biomed Inform. 2022;127:103994. Choi E, Bahadori MT, Song L, Stewart WF, Sun J. GRAM: graph-based attention model for healthcare representation learning. In: Proceedings of the 23rd ACM SIGKDD International Conference on Knowledge Discovery and Data Mining; 2017. p. 787-95. Shang J, Xiao C, Ma T, Li H, Sun J. GAMENet: graph augmented memory networks for recommending medication combination. Proc AAAI Conf Artif Intell. 2019;33(1):1126-33. Mao C, Yao L, Luo Y. MedGCN: medication recommendation and lab test imputation via graph convolutional networks. J Biomed Inform. 2022;127:104000. Lu H, Uddin S. A weighted patient network-based framework for predicting chronic diseases using graph neural networks. Sci Rep. 2021;11(1):22607. Wu Z, Pan S, Chen F, Long G, Zhang C, Yu PS. A comprehensive survey on graph neural networks. IEEE Trans Neural Netw Learn Syst. 2021;32(1):4-24. Zhou J, Cui G, Hu S, Zhang Z, Yang C, Liu Z, et al. Graph neural networks: a review of methods and applications. AI Open. 2020;1:57-81. Das IG, Ringel JB, Rajan M, Colantonio LD, Safford MM, Kern LM. Fragmented ambulatory care and medication count among older adults. Am J Med Qual. 2025;40(3):90-6. Ong MS, Olson KL, Chadwick L, Liu C, Mandl KD. The impact of provider networks on the co-prescriptions of interacting drugs: a claims-based analysis. Drug Saf. 2017;40(3):263-72. DuGoff EH, Fernandes-Taylor S, Weissman GE, Huntley JH, Pollack CE. A scoping review of patient-sharing network studies using administrative data. Transl Behav Med. 2018;8(4):598-625. Breslau J, Dana B, Pincus H, Horvitz-Lennon M, Matthews L. Empirically identified networks of healthcare providers for adults with mental illness. BMC Health Serv Res. 2021;21(1):777. Vlaanderen FP, de Man Y, Tanke MA, Munneke M, Atsma F, Meinders MJ, et al. Density of patient-sharing networks: impact on the value of Parkinson care. Int J Health Policy Manag. 2022;11(7):1132-41. Korsberg A, Cornelius SL, Awa F, O'Malley J, Moen EL. A scoping review of multilevel patient-sharing network measures in health services research. Med Care Res Rev. 2025;82(3):203-24. Ramelson H, Nederlof A, Karmiy S, Neri P, Kiernan D, Krishnamurthy R, et al. Closing the loop with an enhanced referral management system. J Am Med Inform Assoc. 2018;25(6):715-21. Zehner ME, Kirsch JA, Adsit RT, Gorrilla A, Hayden K, Skora A, et al. Electronic health record closed-loop referral ("eReferral") to a state tobacco quitline: a retrospective case study of primary care implementation challenges and adaptations. Implement Sci Commun. 2022;3(1):107. Fouladvand S, Gomez FR, Nilforoshan H, Schwede M, Noshad M, Jee O, et al. Graph-based clinical recommender: predicting specialists procedure orders using graph representation learning. J Biomed Inform. 2023;143:104407. Boll HO, Amirahmadi A, Ghazani MM, de Morais WO, de Freitas EP, Soliman A, et al. Graph neural networks for clinical risk prediction based on electronic health records: a survey. J Biomed Inform. 2024;151:104616. Murali L, Gopakumar G, Viswanathan DM, Nedungadi P. Towards electronic health record-based medical knowledge graph construction, completion, and applications: a literature study. J Biomed Inform. 2023;143:104403. Tariq A, Kaur G, Su L, Gichoya J, Patel B, Banerjee I. Adaptable graph neural networks design to support generalizability for clinical event prediction. J Biomed Inform. 2025;163:104794.