The Structure of Critical Care Transfer Networks
dc.contributor.author | Iwashyna, Theodore J. | |
dc.contributor.author | Christie, Jason D. | |
dc.contributor.author | Moody, James | |
dc.contributor.author | Kahn, Jeremy M. | |
dc.contributor.author | Asch, David A. | |
dc.date.accessioned | 2009-06-24T18:27:54Z | |
dc.date.available | 2009-06-24T18:27:54Z | |
dc.date.issued | 2009-07 | |
dc.identifier.citation | Medical Care 2009;47(7):787-793 <http://hdl.handle.net/2027.42/63027> | en |
dc.identifier.issn | 0025-7079/09/4707-0787 | |
dc.identifier.uri | https://hdl.handle.net/2027.42/63027 | |
dc.description.abstract | Rationale: Moving patients from low-performing hospitals to high-performing hospitals may improve patient outcomes. These transfers may be particularly important in critical care, where small relative improvements can yield substantial absolute changes in survival. Objective: To characterize the existing critical care network in terms of the pattern of transfers. Methods: In a retrospective cohort study, the nationwide 2005 Medicare fee-for-service claims were used to identify the interhospital transfer of critically ill patients, defined as instances where patients used critical care services in 2 temporally adjacent hospitalizations. Measurements: We measured the characteristics of the interhospital transfer network and the extent to which intensive care unit patients are referred to each hospital in that network--a continuous quantitative measure at the hospital-level known as centrality. We evaluated associations between hospital centrality and organizational, medical, surgical, and radiologic capabilities. Results: There were 47,820 transfers of critically ill patients among 3308 hospitals. 4.5% of all critical care stays of any length involved an interhospital critical care transfer. Hospitals transferred out to a mean of 4.4 other hospitals. More central hospital positions were associated with multiple indicators of increased capability. Hospital characteristics explained 40.7% of the variance in hospitals' centrality. Conclusions: Critical care transfers are common, and traverse an informal but structured network. The centrality of a hospital is associated with increased capability in delivery of services, suggesting that existing transfers generally direct patients toward better resourced hospitals. Studies of this network promise further improvements in patient outcomes and efficiency of care. * Note, if you find this of interest, you may also be interested in the follow-up manuscript exploring the determinants and efficiency of the network in targeting transfers for patients with acute myocardial infarction (AMI, aka heart attacks) at http://hdl.handle.net/2027.42/78005 | en |
dc.description.sponsorship | Supported in part by NIH grants HL07891-09 and K08 HL09 1249 and an ATS Fellows Career Development Award | en |
dc.format.extent | 3165825 bytes | |
dc.format.mimetype | application/pdf | |
dc.language.iso | en_US | en |
dc.publisher | Medical Care | en |
dc.subject | Networks | en |
dc.subject | Critical Care | en |
dc.subject | Regionalization | en |
dc.subject | Medical Care | en |
dc.title | The Structure of Critical Care Transfer Networks | en |
dc.type | Article | en |
dc.subject.hlbsecondlevel | Internal Medicine and Specialities | |
dc.subject.hlbtoplevel | Health Sciences | |
dc.description.peerreviewed | Peer Reviewed | en |
dc.contributor.affiliationum | Pulmonary and Critical Care Medicine, Division of | en |
dc.contributor.affiliationum | Internal Medicine, Department of | en |
dc.contributor.affiliationother | University of Pennsylvania | en |
dc.contributor.affiliationother | Duke University | en |
dc.contributor.affiliationumcampus | Ann Arbor | en |
dc.description.bitstreamurl | http://deepblue.lib.umich.edu/bitstream/2027.42/63027/1/09.Medical.Care.Network.Structure.pdf | |
dc.owningcollname | Pulmonary & Critical Care Medicine, Division of |
Files in this item
Remediation of Harmful Language
The University of Michigan Library aims to describe library materials in a way that respects the people and communities who create, use, and are represented in our collections. Report harmful or offensive language in catalog records, finding aids, or elsewhere in our collections anonymously through our metadata feedback form. More information at Remediation of Harmful Language.
Accessibility
If you are unable to use this file in its current format, please select the Contact Us link and we can modify it to make it more accessible to you.