The interhospital transfer network for very low birth weight infants in the United States

Abstract

Very low birth weight (VLBW) infants require specialized care in neonatal intensive care units. In the United States (U.S.), such infants frequently are transferred between hospitals. Although these neonatal transfer networks are important, both economically and for infant morbidity and mortality, the national level pattern of neonatal transfers is largely unknown. Using data from Vermont Oxford Network on 44,753 births, 2122 hospitals, and 9722 interhospital infant transfers from 2015, we performed the largest analysis to date on the interhospital transfer network for VLBW infants in the U.S. We find that transfers are organized around regional communities, but that despite being largely within state boundaries, most communities often contain at least two hospitals in different states. To classify the structural variation in transfer pattern amongst these communities, we applied a spectral measure for regionalization and found an association between a community's degree of regionalization and their infant transfer rate, which was not utilized in detecting communities. We also demonstrate that the established measures of network centrality and hierarchy, e.g., the community-wide entropy in PageRank or betweenness centrality and number of distinct "layers, " within a community, correlate weakly with our regionalization index and were not significantly associated with metrics on infant transfer rate. Our results suggest that the regionalization index captures novel information about the structural properties of VLBW infant transfer networks, have the practical implication of characterizing neonatal care in the U.S., and may apply more broadly to the role of centralizing forces in organizing complex adaptive systems.

Using hospital network-based surveillance for antimicrobial resistance as a more robust alternative to self-reporting

“…The proposed surveillance scheme exploits the structure of the hospital network, showing the added value of regarding hospitals as interconnected by shared patients instead of completely independent and isolated entities[8–12]. Furthermore, the proposed surveillance scheme will likely work in other health care systems in other countries with similar hospital networks consisting of regional groups with large (teaching) hospitals acting as highly connected hubs, such as USA, Netherlands and France [8–10,13–15]. Although the ideal reporting threshold, as well as the required reporting set size would need to be determined on a per country basis, the general principal still applies.…”

“…The influence of the hospital network formed by shared patients on the spread of hospital-associated pathogens has also been used to design early warning systems[16,17] or inform the distribution of resources for IPC[18], often reiterating the importance of centrally located hospitals. Previous studies have shown that patient sharing between hospitals significantly correlate with rates of Carbapenemase-Producing Enterobacteriaceae (CPE)[19], MRSA[20] or Clostridium difficile[15,16]. We present a novel viewpoint on using these hospital networks, by considering the interests of hospitals to report cases, thus actively using the shared patients to combat the spread of these pathogens.…”

A Conceptual Framework for Optimizing the Equity of Hospital‐Based Emergency Care: The Structure of Hospital Transfer Networks

“…The structure of these networks can be directly observed through contractual relationships between initial and receiving hospitals or inferred through empirical data on transfers, such as using administrative data 75,76 . Whereas studies have used network analysis techniques to measure and visualize the structure of provider networks, 77–80 relatively few studies have explicitly examined the structure of transfer networks in the United States 77,79–85 . International research on hospital transfer networks 76,86–89 is outside the scope of this paper because of differences in the environments.…”

“…For instance, 91% of neonatal transports remain within the perinatal referral regions defined by state of California 85 . However, these policies may be limited for patients with specialized needs; state‐level policies may have less of an influence on when very low birth weight infants are transferred 84 …”

Vermont Oxford Network: a worldwide learning community

“…The large number of cases in the databases support research on outcomes in specific populations, such as infants with necrotizing enterocolitis (17,18,(60)(61)(62)(63), gastroschisis (64,65), and hypoplastic left heart syndrome (66). Topics in health services research and newborn care include neonatal care utilization in the United States (16,67) and internationally (68), nurse staffing (69)(70)(71)(72), and disparities in care (73)(74)(75)(76).…”