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| Title: | Uncharted Paths: Hospital Networks in Critical Care |
| Authors: | Iwashyna, Theodore J.
Christie, Jason D.
Kahn, Jeremy M.
Asch, David A. |
| Keywords: | Critical Care
Networks
Transfers |
| Issue Date: | Mar-2009 |
| Publisher: | Chest |
| Citation: | Chest (135)5:2009:827-833 <http://hdl.handle.net/2027.42/61909> |
| Abstract: | Wide variation between hospitals in the quality of critical care lead to many potentially avoidable
deaths. Regionalization of critical care is a possible solution; regionalization has been implemented
for trauma and neonatal intensive care, and it is under active discussion for medical and cardiac critical
care. However, regionalization is only one possible approach to reorganizing critical care services. This
commentary introduces the technique of network analysis as a framework for the following: (1)
understanding how critically ill patients move between hospitals, (2) defining the roles hospitals play
in regional care delivery, and (3) suggesting systematic improvements that may benefit population
health.
We examined transfers of critically ill Medicare patients in Connecticut in 2005 as a model system. We
found that patients are systematically transferred to more capable hospitals. However, we find the
standard distinction of hospitals into either “secondary hospitals” or “tertiary hospitals” poorly
explains observed transfer patterns; instead, hospitals show a continuum of roles. We further examine
the implications of the network pattern in a simulation of quarantine of a hospital to incoming
transfers, as occurred during the severe acute respiratory syndrome epidemic.
Network perspectives offer new ways to study systems to care for critically ill patients and provide
additional tools for addressing pragmatic problems in triage and bed management, regionalization,
quality improvement, and disaster preparedness. (CHEST 2009; 135:827– 833) |
| DOI: | DOI: 10.1378/chest.08-1052 |
| Appears in Collections: | Interdisciplinary and Peer-Reviewed
Pulmonary & Critical Care Medicine, Division of
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| 09.I.Christie.Asch.Kahn.09.Chest.pdf | | 504Kb | Adobe PDF | View/Open |
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