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The structure of critical care transfer networks.

Publication ,  Journal Article
Iwashyna, TJ; Christie, JD; Moody, J; Kahn, JM; Asch, DA
Published in: Medical care
July 2009

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.To characterize the existing critical care network in terms of the pattern of transfers.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.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.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.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.

Duke Scholars

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Published In

Medical care

DOI

EISSN

1537-1948

ISSN

0025-7079

Publication Date

July 2009

Volume

47

Issue

7

Start / End Page

787 / 793

Related Subject Headings

  • United States
  • Travel
  • Survival Rate
  • Statistics, Nonparametric
  • Sensitivity and Specificity
  • Retrospective Studies
  • Referral and Consultation
  • Patient Transfer
  • Outcome Assessment, Health Care
  • Medicare
 

Citation

APA
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Iwashyna, T. J., Christie, J. D., Moody, J., Kahn, J. M., & Asch, D. A. (2009). The structure of critical care transfer networks. Medical Care, 47(7), 787–793. https://doi.org/10.1097/mlr.0b013e318197b1f5
Iwashyna, Theodore J., Jason D. Christie, James Moody, Jeremy M. Kahn, and David A. Asch. “The structure of critical care transfer networks.Medical Care 47, no. 7 (July 2009): 787–93. https://doi.org/10.1097/mlr.0b013e318197b1f5.
Iwashyna TJ, Christie JD, Moody J, Kahn JM, Asch DA. The structure of critical care transfer networks. Medical care. 2009 Jul;47(7):787–93.
Iwashyna, Theodore J., et al. “The structure of critical care transfer networks.Medical Care, vol. 47, no. 7, July 2009, pp. 787–93. Epmc, doi:10.1097/mlr.0b013e318197b1f5.
Iwashyna TJ, Christie JD, Moody J, Kahn JM, Asch DA. The structure of critical care transfer networks. Medical care. 2009 Jul;47(7):787–793.

Published In

Medical care

DOI

EISSN

1537-1948

ISSN

0025-7079

Publication Date

July 2009

Volume

47

Issue

7

Start / End Page

787 / 793

Related Subject Headings

  • United States
  • Travel
  • Survival Rate
  • Statistics, Nonparametric
  • Sensitivity and Specificity
  • Retrospective Studies
  • Referral and Consultation
  • Patient Transfer
  • Outcome Assessment, Health Care
  • Medicare