Arizona Cancer Coalition
Network structures and research collaboration in a statewide cancer coalition
Presented by:
Judith C. Keagy, MHA, FACHE
Judith
C Keagy MHA FACHE
Doctoral Student
University of Arizona
With acknowledgement and thanks to my co‐authors:
Keith Provan, PhD ‐ Eller College of Management,
Scott Leishow, PhD ‐ Arizona Cancer Center, and
J
Jesse Nodora, DrPH
N d
D PH ‐ Arizona Cancer Center
Ai
C
C t
“Research collaboration in the discovery, development, and delivery networks of a statewide cancer coalition”, Evaluation and Program Planning (Article in Press & Pending Publication)
School of Government and Public Policy
Relevant Literature
• Collaboration is critical for enhancing effectiveness of health and human services systems (Alter & Hage, 1993; Provan & Milward, 1995; Banaszak‐Holl, Allen, Mor, & Schott, 1998; Bazzoli, Casey, Alexander et al 2003; NCI 2007)
Alexander et al., 2003; NCI, 2007)
• And
And for building community capacity in public for building community capacity in public
health and medical communities (Chaskin et al., 2001; Leischow et al 2008; Valente et al 2008)
2001; Leischow et al., 2008; Valente et al., 2008)
•
Relevant Literature (cont.)
• Network management is particularly challenging in public health ((Varda et al., 2008)… p
,
) need to understand distinction among types of cross‐sectoral public/private networks (Milward & Provan, 2006)
• Need for a systems approach to coordination of translational research through networks, and l
l
h h
h
k
d
coalitions (HHS, 2007, NCI, 2005). • Use of SNA by researchers to study organizational networks and knowledge diffusion in health
networks and knowledge diffusion in health services, public health and biotechnology (Luke & Harris, 2007; Valente et al., 2008; Varda et al., 2008, Powell et al., 2005)
2007; Valente et al., 2008; Varda et al., 2008, Powell et al., 2005
Presentation Objectives
Project: Network analysis of research collaboration within a statewide cancer control and prevention coalition. p
– Historical context
– Baseline exploratory study ‐ Results
– Phase 2 project plan
Phase 2 project plan
Historical Context
2003 – ADHS receives CDC grant
2005 ‐ Statewide CancerCoalition Established &
AZ Comprehensive Cancer Control Plan Developed
2007 AZCCC Research Cte.. Initiates Baseline Study
2007 –
AZCCC R
hC
I ii
B li S d
2010 – Phase 2 Study Planned
Baseline Study – Research Questions
1. What is the structure of network relations among the involved organization?
the involved organization? 2. Does the structure of network relations and the centrality of organizations differ by type of 3D research? 3. To what extent is position in the network related to p
the importance of cancer research to the g
organization’s mission?
4. What role does the state health department
p
(the
( lead
organization) play in this type of network?
Study Population
Study Population
• Study population:
– Surveyed Population of Organizations
21
– Total Number of Respondent Organizations 18
– Response Rate 85.7%
• Included variety of organizational types:
State public health agency
Academic institutions
Private research institutes
Health care facilities
Support/advocacy organizations
Methods
• Network analysis – focus is on the ‘whole’ network not just dyadic or partnership
network, not just dyadic or partnership relationships.
• Data Collection Data Collection – Timeframe Summer/Fall 2007:
Timeframe Summer/Fall 2007:
– Survey questionnaire to key informants – Network data for each organization kd
f
h
– Descriptive data for each organization • Social Network Analysis –
Social Network Analysis – Primary analytic tool
Primary analytic tool
Network Measures
Network Measures
• Two global measures of network structure –
g
network centralization & network density.
• One organization level measure – degree centrality. t lit
• Used only “confirmed” ties for this analysis
Network Analysis
Network Analysis
• Produced network plots one for each of the 3D p
networks and one consolidated “any links” network p
p
that depict the relationships in 2007
• Individual
Individual nodes coded by color and shape showing nodes coded by color and shape showing
importance of cancer research activity to the overall mission of that organization
mission of that organization.
Discovery Network ‐ (Confirmed)
Network Measures: Centralization = .436; Density = .118
Network Measures:
Centralization = 436; Density = 118
Key: Cancer Research Activities – Relationship to Mission
██ = Extremely
E t
l Essential/Very
E
ti l/V
Central
C t l
♦
= Modestly Central
▲ = Not Very/Only Minimally Central
Development Network ‐ (Confirmed)
Network Measures: Centralization = .429; Density = .065
Network Measures:
Centralization = 429; Density = 065
Key: Cancer Research Activities – Relationship to Mission
██ = Extremely
E t
l Essential/Very
E
ti l/V
Central
C t l
♦
= Modestly Central
▲ = Not Very/Only Minimally Central
Delivery Network ‐ (Confirmed)
Network Measures: Centralization = .491; Density = .124
Network Measures:
Centralization = 491; Density = 124
Key: Cancer Research Activities – Relationship to Mission
██ = Extremely
E t
l Essential/Very
E
ti l/V
Central
C t l
♦
= Modestly Central
▲ = Not Very/Only Minimally Central
Consolidated (Any Links) Network ‐ (Confirmed)
Network Measures: Centralization = .678; Density = .242
Network Measures:
Centralization = 678; Density = 242
Key: Cancer Research Activities – Relationship to Mission
██ = Extremely
E t
l Essential/Very
E
ti l/V
Central
C t l
♦
= Modestly Central
▲ = Not Very/Only Minimally Central
Summary – Network Measures
Summary Network Measures
The 3D Network Measures:
Density The Delivery network is the most highly Density –
The Delivery network is the most highly
connected (12.4%) followed closely by Discovery (
(11.8%) with Development bringing up the rear (6.5%).
)
p
g g p
(
)
Centralization – The 3D networks are moderately y
centralized, with similar centralization scores ‐ Delivery (.491), Discovery (.436) and Development (.429). The ‘Any Link’ Network Measures:
The Consolidated ‘Any Link’
h
lid d ‘
i k’ network was the most k
h
dense (24.2%). It was also the most centralized (.678). Correlation Matrix of Measures of Network Centrality and Research Mission (n=18) y
(
)
1. Discovery
1. Discovery
Mean S.D. 2.0
2.0 2.66
2.66 2. Development
1.1 1.91 1 2 3 4 .71 (.001) 3. Delivery 2.1 2.45 .33 .77 (NS)
( 001)
(.001) 4. All Links 4.1 3.86 .83 .77 .73 ((.001)) ((.001)) ((.001) )
5. Research Mission* 2.0 0.84 .61
.51 .20 .43 (.01)
(.05)
(NS)
(.10)
• Pearson correlation coefficients are reported. Significance level (p<) l
ff
d
f
l l( )
reported in parentheses. Organizations were coded as 1 (not very essential), 2 (modestly essential), or 3 (highly essential) based on self‐
reports from the survey.
(Quadratic Assignment Procedure) QAP correlation analysis
y
 QAP compares relationships in one network with those of another ha ing the same actors
those of another having the same actors.
 QAP RESULTS:
 Discovery and Development (r=.40, p<.05)
 Delivery and Development (r=.46, p<.01)
Delivery and Development (r= 46 p< 01)
 Discovery and Delivery (r=.17, not significant)
Key Findings from Baseline Study
• Discovery and delivery networks are more active than the development ; but their relationship structures are quite different. diff
• Organizations with highest to cancer research maintain central positions in both the discovery and development networks, but not in delivery network (except AzCC) where other org types are
not in delivery network (except AzCC), where other org. types are part of the core group (i.e. ADHS).
• ADHS organized and sponsors the cancer control network but wasn’t perceived as very central to network’s research activities. p
y
Why? How does this compare to other types of public/private networks. Other Key Findings & Concerns
• Lack of ties, gaps in Development research across full ,g p
p
network.
• Use of the 3D research continuum as the framework for the study – several pros and cons.
• Possible disconnect between adult and pediatric cancer research based on relative isolation of PCH
cancer research based on relative isolation of PCH.
Contribution
• Network analysis shows who is collaborating and who is not –
h
can be used to foster additional ties to b
d f
dd
l
optimize statewide research efforts.
• Importance of leadership role across all 3 dimensions (3Ds) of the research continuum as a means of improving translational research.
• This empirical study will add to the knowledge base p
y
g
concerning these kinds of chronic disease coalition p
g
networks and the role of public health agencies in network sponsorship and management.
• Focus on network evolution Focus on network evolution ‐ Longitudinal vs. cross
Longitudinal vs cross‐
sectional. Limitations
• Small sample in only one state, focusing only on p
y
,
g
y
members of AZ Cancer Coalition.
• Reliability of some key informants.
Reliability of some key informants
• Self‐identification of network participants & non‐
participants.
participants
• Focus limited to cancer research versus whole network across the spectrum of cancer control activities.
th
t
f
t l ti iti
• Possible confusion about discovery vs. development vs. d li
delivery
Phase 2 – Longitudinal Research Questions
• What is the nature and extent of collaboration among research organizations in a statewide public health cancer control and g
p
prevention coalition? • Does the structure of network relations differ when research activities are differentiated by discovery, development, and delivery? • Is position in the research network related to the importance of the task; in this case, cancer research, for the organization as a whole? whole?
• How have network relations changed over time? • How does the structure of this “coalition
How does the structure of this “coalition‟ network compare with network compare with
what previous research tells us about the structure of “service implementation‟ networks? implementation
networks?
Network Effectiveness Expansion of Network Membership:
• Has
Has study population expanded to include new categories of study population expanded to include new categories of
organizations in the network? How does wider network structure compare with that of baseline study participants?
• If the network has expanded, does ADHS, the coalition sponsor, play a more central role in linking these additional community‐
based participants to the original core organizations involved in cancer care and research
d
h
Information Diffusion/Goal Consensus:
/
• How has information on research initiatives diffused among the participants and how do network members perceive the need for their participation in these activities?
Phase 2 – Research Design & Methods
Same basic research design as baseline study
• Will
Will add supplemental questions to get at network add supplemental questions to get at network
effectiveness.
• Will add semi‐structured interviews with organizational leaders to gather additional qualitative feedback on network functioning & effectiveness
Arizona Cancer Coalition
• Questions??
• Comments??
• Suggestions??
School of Government and Public Policy
Supplementary Information
• As needed
School of Government and Public Policy
Results: Arizona Cancer Research – Organizational Network Analysis
Bounding the Network: Initial Population of Organizations: Surveyed Population of Organizations*
p
g
Total Number of Respondent Organizations
Response Rate *after collapsing hospital systems & exclusion of purely clinical trials organizations.
Respondent Organization Name:
Respondent
Organization Name:
Arizona Cancer Center/Univ. of AZ
American Cancer Society/AZ Chapter
Arizona Department of Health Services
Banner Health System
Banner Health System
BIO5/Univ. of Arizona
BioDesign/AZ State Univ.
Flagstaff Regional MC/Cancer Center No. AZ
Inter Tribal Council of Arizona
Inter‐Tribal Council of Arizona
Mayo Clinic – Scottsdale
Northern Ariz. University
Phoenix Children's Hospital
Phoenix Indian Medical Center
Phoenix Indian Medical Center
St. Joseph Hospital & MC (Phx)/Barrows
Sun Health Research Institute
Translational Genomics
T
Tucson Medical Center
M di l C t
Veterans Admin. Med. Ctr. So. AZ
Scottsdale Healthcare/Virgina Piper 34
21
18
85.7%
Designation Code:
Designation
Code:
AZCC/UA
ACS
ADHS
BANNER HS
BANNER HS
BIO5/UA
BIOD/ASU
FMC/CCNA
ITCA
MAYO SCT
NAU
PCH
PIMC
STJ PHX/BRWNI
SUNHLTHR
TGEN
TMC
VAMC SAZ
SCTSDL HC/VP
Process Framework: Evaluating CA research network evolution & effectiveness – The model shows steps in the process leading from inception of a statewide cancer control coalition to evaluating the evolution of collaboration among organizations involved in cancer research over time. The model incorporates: 1) a longitudinal comparison of the nature & structure of cancer research network relationships in 2007 & 2010; 2) an analysis of organizational & relational characteristics associated with network participation, and; 3) an evaluation of coalition effectiveness related to intermediate outcomes, including those linked to the research network’s primary goal… achieving increased participation by community‐based organizations in coalition and involvement in/awareness of research activities (See lighter blue i
l
hi i i
d
ti i ti b
it b d
i ti
i
liti
di
l
ti /
f
h ti iti (S li ht bl
shaded area.)
AZ Cancer Control Needs/Resource Assessment. Development of 2005
2005 Implement Statewide Cancer Control Coalition –Develop working groups of key stakeholders to address a wide range of cancer control activities* including a sub group of organizations engaged in cancer
activities*, including a sub‐group of organizations engaged in cancer research activities.
Comprehensive
CA Control Plan*
CA Control Plan
Research Goal:
Enhance collaboration among organizations doing cancer research in Arizona
Promote tissue banking
Promote participation in clinical trials
Increase underrepresented populations’ participation in clinical research.
Priority‐Setting
Action Planning
Action Planning
2007
2010
Intermediate Outcomes
Intermediate Outcomes
Baseline Research Network Analysis
Analysis of Current Research Network
Evidence of enhanced collaboration among organizations involved in cancer research?
(Evaluated which & how organizations collaborate in CA i ti
ll b t i CA
research activities.)
Other CA Research Objectives:
Improve access/avail. CA data
Identify/Address gaps/barriers in connectivity
d
f / dd
/b
Collective Decision‐
Making
Research results translated from ‘Bench’ to ‘Bedside’ through network ‘B
h’ t ‘B d id ’ th
h t
k
collaboration. Improve targeting of prevention & treatment interventions to needs of underserved populations.
Strategic Planning:
Cancer Research Cte.
Desired Outcomes
2008/2009
Developed AZ Pilot l
d
l
Initiative for Clinical Trials – An education and system change approach
Broaden/improve engagement of cancer care systems in change
cancer care systems in change strategies. Engage community‐based organizations & leaders to increase diversity of participants
1) Evaluate changes in organizational relationships, network structure & membership via network analysis
membership via network analysis.
‐‐‐‐‐‐‐‐‐‐‐‐------------------------------------------
Are there lessons to be learned about how to organize & manage 2) Analyze which, how & why organizations collaborate in CA research network.
heterogeneous public health yp
coalitions of this type?
----------------------------------------------------
Evidence of increased membership diversity and involvement in &/or awareness of coalition’s research activities
research activities. 3) Assess increased diversity in network membership, i.e. community‐based participants; increased awareness of & commitment to coalition’s research agenda/initiatives.
*The AZ Comprehensive Cancer Control Plan & resultant statewide Cancer Control Coalition includes chapters/subnetworks working on prevention, early detection & screen, diagnosis & treatment, quality of life, and disparities, in addition to the research network .
Question 3 ‐ % of total cancer‐related budget related to research?
N
17
Mean
M
33.9%
SS.D.
D
0.343
Question 4 ‐ % of cancer research budget spent on following research categories:
N
17
Mean
30.9%
S.D.
0.288
Development
p
17
17.2%
0.163
Delivery
51.9%
0.318
Discovery
17