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CISummit 2013: Nicholas Christakis, Using Social Networks and Social Influence to Affect the...

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Social Network Interventions Twitter: @NAChristakis Nicholas A. Christakis, MD, PhD Human Nature Lab Yale Institute for Network Science Yale University
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Page 1: CISummit 2013: Nicholas Christakis, Using Social Networks and Social Influence to Affect the Behavior of Physcians

Social Network Interventions!

Twitter: @NAChristakis!

Nicholas A. Christakis, MD, PhD!Human Nature Lab!Yale Institute for Network Science!Yale University!

Page 2: CISummit 2013: Nicholas Christakis, Using Social Networks and Social Influence to Affect the Behavior of Physcians

Human Networks Have a Consistent Structure!

Network Interventions

Page 3: CISummit 2013: Nicholas Christakis, Using Social Networks and Social Influence to Affect the Behavior of Physcians

Network Interventions

Observations and Experiments on Social Contagion!

Obesity! Smoking! Drinking! Drug Use!

Happiness! Loneliness! Depression! Altruism!

Sleep! Exercise! Purchases! Ideas!

Page 4: CISummit 2013: Nicholas Christakis, Using Social Networks and Social Influence to Affect the Behavior of Physcians

Network Interventions

Connections Matter!

Page 5: CISummit 2013: Nicholas Christakis, Using Social Networks and Social Influence to Affect the Behavior of Physcians

Network Interventions

GRAPHITE!

Connections Matter!

DIAMOND!

Page 6: CISummit 2013: Nicholas Christakis, Using Social Networks and Social Influence to Affect the Behavior of Physcians

Connections Matter!

source: Brian Uzzi!

Network Interventions

Page 7: CISummit 2013: Nicholas Christakis, Using Social Networks and Social Influence to Affect the Behavior of Physcians

Network Interventions

Connection: changing the structure!!!Contagion: changing the flows !

Intervening in Social Networks!

Page 8: CISummit 2013: Nicholas Christakis, Using Social Networks and Social Influence to Affect the Behavior of Physcians

Network Interventions

Manipulating Connection!ONLINE NETWORK!

D. Centola, “The Spread of Behavior in an Online Social Network Experiment,” Science 2010; 329: 1194-1197!

NEIGHBORHOOD!RANDOM!

Page 9: CISummit 2013: Nicholas Christakis, Using Social Networks and Social Influence to Affect the Behavior of Physcians

Networks & Evolution

D. G. Rand, S. Arbesman, and N.A. Christakis, “Dynamic Social Networks Promote Cooperation in Experiments with Humans,” PNAS 108: 19193-19198 (2011)

Cooperation!and Re-Wiring!

EXPERIMENTS!

Fluid!

Fixed!

Round! 1! 2! 6! 10!

Page 10: CISummit 2013: Nicholas Christakis, Using Social Networks and Social Influence to Affect the Behavior of Physcians

Network Interventions

EXPERIMENT 1: RANDOM PEOPLE!

PEER EFFECTS UNDER CONTROL!

Manipulating Contagion!

Page 11: CISummit 2013: Nicholas Christakis, Using Social Networks and Social Influence to Affect the Behavior of Physcians

Network Interventions

PEER EFFECTS UNDER ACCELERATION!

EXPERIMENT 2: CENTRAL PEOPLE!

Manipulating Contagion!

Page 12: CISummit 2013: Nicholas Christakis, Using Social Networks and Social Influence to Affect the Behavior of Physcians

Network Interventions

Las Marias!HONDURAS!

Page 13: CISummit 2013: Nicholas Christakis, Using Social Networks and Social Influence to Affect the Behavior of Physcians

Network Interventions

Village Networks!HONDURAS!

Page 14: CISummit 2013: Nicholas Christakis, Using Social Networks and Social Influence to Affect the Behavior of Physcians

Network Interventions

Delivering the!Intervention!HONDURAS VILLAGES!

Page 15: CISummit 2013: Nicholas Christakis, Using Social Networks and Social Influence to Affect the Behavior of Physcians

Network Interventions

Mean proportion

of coupons redeemed!

Day!

nominated, 9 villages: 0.8 in-degree, 9 villages: 0.7 random, 7 villages: 0.66

1.0!

!

0.8!

!

0.6!

!

0.4!

!

0.2!

!

0.0!

0! 2! 4! 6! 8! 10! 12! 14!

VITAMINS IN HONDURAS!

Network Targeting!

Page 16: CISummit 2013: Nicholas Christakis, Using Social Networks and Social Influence to Affect the Behavior of Physcians

Network Interventions

Social Contagion!

VILLAGE EXPERIMENTS!

Page 17: CISummit 2013: Nicholas Christakis, Using Social Networks and Social Influence to Affect the Behavior of Physcians

Network Interventions

Physician!Networks!

SHARED PATIENTS!

2!

1!

1!

1!

Page 18: CISummit 2013: Nicholas Christakis, Using Social Networks and Social Influence to Affect the Behavior of Physcians

Network Interventions

BOSTON HOSPITALS!

B.E. Landon, N.L. Keating, M.L. Barnett, J.P. Onnela, S. Paul, A.J. O’Malley, T. Keegan, and N.A. Christakis, “Variation in Patient-Sharing Networks of Physicians Across the United States,” JAMA 2012; 308: 265-273 !

Physician!Networks!

Page 19: CISummit 2013: Nicholas Christakis, Using Social Networks and Social Influence to Affect the Behavior of Physcians

Physician Networks!

Network Interventions

M. Barnett, N.A. Christakis, A.J. O’Malley, J.P. Onnela, N.L. Keating, and B. Landon, “Physician Patient-Sharing Networks and the Cost and Intensity of Care in US Hospitals,” Medical Care 2012; 50: 152-160!

Page 20: CISummit 2013: Nicholas Christakis, Using Social Networks and Social Influence to Affect the Behavior of Physcians

Network Interventions

Physician!Networks!

HOSPITAL SPENDING!

M. Barnett, N.A. Christakis, A.J. O’Malley, J.P. Onnela, N.L. Keating, and B. Landon, “Physician Patient-Sharing Networks and the Cost and Intensity of Care in US Hospitals,” Medical Care 2012; 50: 152-160!

Page 21: CISummit 2013: Nicholas Christakis, Using Social Networks and Social Influence to Affect the Behavior of Physcians

JANUVIA PRESCRIPTIONS!

Network Interventions

40 – 57 shared patients!58 – 106 shared patients!

107+ shared patients!

!

did not use Januvia!

used Januvia!!

0 – 57 prescriptions!

58 – 328 prescriptions!

329+ prescriptions!

Source: www.ActivateNetworks.net!

Physician!Networks!

Page 22: CISummit 2013: Nicholas Christakis, Using Social Networks and Social Influence to Affect the Behavior of Physcians

Prescribers of Statins, 2009!

Adop%ng    Crestor  +  Generics  

Source: www.ActivateNetworks.net!

Page 23: CISummit 2013: Nicholas Christakis, Using Social Networks and Social Influence to Affect the Behavior of Physcians

Prescribers of Statins, 2012!

Source: www.ActivateNetworks.net!

Adop%ng    Crestor  +  Generics  

Page 24: CISummit 2013: Nicholas Christakis, Using Social Networks and Social Influence to Affect the Behavior of Physcians

Overall Change in Market Share!

Lipitor  

Crestor  

Generics  

Source: www.ActivateNetworks.net!

Page 25: CISummit 2013: Nicholas Christakis, Using Social Networks and Social Influence to Affect the Behavior of Physcians

Community Differences!

Various colors indicate different communities

Source: www.ActivateNetworks.net!

Page 26: CISummit 2013: Nicholas Christakis, Using Social Networks and Social Influence to Affect the Behavior of Physcians

January  2009   January  2012  

Source: www.ActivateNetworks.net!

Influencers Make the Difference  

Page 27: CISummit 2013: Nicholas Christakis, Using Social Networks and Social Influence to Affect the Behavior of Physcians

January  2009   January  2012  

Source: www.ActivateNetworks.net!

Influencers Make the Difference  

Page 28: CISummit 2013: Nicholas Christakis, Using Social Networks and Social Influence to Affect the Behavior of Physcians

Network Interventions

Deliberately Creating Spillovers!!Deliberately Exploiting Peer Reinforcement!

Network Effects!ENHANCING BEHAVIORAL INTERVENTIONS!

Page 29: CISummit 2013: Nicholas Christakis, Using Social Networks and Social Influence to Affect the Behavior of Physcians

Network Interventions

Hospital!Network!

PATIENT TRANSFERS!

Page 30: CISummit 2013: Nicholas Christakis, Using Social Networks and Social Influence to Affect the Behavior of Physcians

Network Interventions

Physician!Networks!

HOSPITAL LEAKAGE!

Edge thickness represents number of patients

Your Hospital

Source: www.ActivateNetworks.net!

Page 31: CISummit 2013: Nicholas Christakis, Using Social Networks and Social Influence to Affect the Behavior of Physcians

Network Interventions

Loyal In The physician shown here is sending patients to your hospital only. These are the physicians to

reward and use as models.

Scattered The highlighted physician is sending patients to multiple different hospitals. This behavior

is likely to be patient-driven.

Loyal Out This physician is sending all of his patients to

one hospital that is not your own. This behavior is likely to be physician-driven.

Physician!Networks!

TYPES OF PHYSICIAN BEHAVIOR!

Source: www.ActivateNetworks.net!

Page 32: CISummit 2013: Nicholas Christakis, Using Social Networks and Social Influence to Affect the Behavior of Physcians

Natural!Network!

Network Interventions

VARIATION IN POSITION!

Page 33: CISummit 2013: Nicholas Christakis, Using Social Networks and Social Influence to Affect the Behavior of Physcians

Network Interventions

CENTRAL PEOPLE!

Network!

Page 34: CISummit 2013: Nicholas Christakis, Using Social Networks and Social Influence to Affect the Behavior of Physcians

Network Interventions

Theoretical Differences in Epidemic Curves!

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TIME TIME

NA Christakis and J H Fowler, “Social Network Sensors for Early Detection of Contagious Outbreaks” PLoS One, 5(9): e12948 !

Page 35: CISummit 2013: Nicholas Christakis, Using Social Networks and Social Influence to Affect the Behavior of Physcians

Network Interventions

Observed Differences in Epidemic Curves!

NA Christakis and J H Fowler, “Social Network Sensors for Early Detection of Contagious Outbreaks” PLoS One, 5(9): e12948 !

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DAYS SINCE SEPTEMBER 1 DAYS SINCE SEPTEMBER 1

0 20 40 60 80 100 120

0.00

0.

02

0.42

0.

06

0.08

0.00

00

0.00

04

0.00

08

0.00

12

0 20 40 60 80 100 120

Page 36: CISummit 2013: Nicholas Christakis, Using Social Networks and Social Influence to Affect the Behavior of Physcians

Network Interventions

PATHOGENS! INFORMATION! NORMS! BEHAVIORS!

Contagious Outbreaks!

Page 37: CISummit 2013: Nicholas Christakis, Using Social Networks and Social Influence to Affect the Behavior of Physcians

Network Interventions

Forecasting Drug Adoption in Physician Networks!

0%

10%

20%

30%

1 3 5 7 9 11 13 15 17 19 21 23 25 27Months

% Ad

optio

n

Average Central

Forecasting Capability!

Page 38: CISummit 2013: Nicholas Christakis, Using Social Networks and Social Influence to Affect the Behavior of Physcians

Network Interventions

Internet (social networks, websites, links, etc.)!Telephony!Video cameras in cities!RFID devices!Administrative records (e.g., physician visits, crimes)!Transaction records!Geographic information!Voluntary losses of anonymity (data wikis)!Personal genetics!

Computational Social Science!PERVASIVE DATA!

Page 39: CISummit 2013: Nicholas Christakis, Using Social Networks and Social Influence to Affect the Behavior of Physcians

Tyco Brahe (1546-1601)!

Network Interventions

Page 40: CISummit 2013: Nicholas Christakis, Using Social Networks and Social Influence to Affect the Behavior of Physcians

www.ConnectedTheBook.net!

Network Interventions

www.HumanNatureLab.net!

www.NicholasChristakis.net!

www.ActivateNetworks.net!

@NAChristakis!


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