Care fragmentation predicts 90-day durable ventricular assist device outcomes.
Care fragmentation predicts 90-day durable ventricular assist device outcomes.
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DOI：
10.37765/ajmc.2022.89280
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发表时间：
2022-12-01
期刊：
影响因子：
--
通讯作者：
Michigan Congestive Heart Failure Investigators
中科院分区：
文献类型：
--
作者：
Funk RJ;Pagani FD;Hou H;Zhang M;Yang G;Malani PN;Chandanabhumma PP;Cabrera L;Kim KD;Likosky DS;Michigan Congestive Heart Failure Investigators
检查护理碎片化是否与持久性心室辅助装置（VAD）植入后的住院和90天结局恶化相关。队列研究本研究是在2009年7月至2017年4月期间接受VAD植入术的患者中使用与胸外科医师协会（STS）机械辅助循环支持（Intermacs）机构间登记相关的医疗保险索赔进行的。医疗保险数据被用来衡量治疗医院的多学科护理提供网络的碎片化，根据提供者在过去一年内共享病人的历史。STS Intermacs数据用于风险调整和结局确定。根据网络碎片化程度，医院被分为几个等级，衡量标准是网络中分离供应商的平均链接数。使用多变量回归将网络碎片与90天死亡或感染风险相关联。该队列包括5159例接受VAD植入的患者，其中11.2%死亡，27.6%在植入后90天内发生感染。调整后，网络碎片增加1个单位与院内感染概率增加0.179和90天感染概率增加0.183相关（均P <0.05）。在住院和90天感染数量的模型中也观察到了类似的结果。网络碎片是预测90天死亡率的概率，尽管这种关系在调整后并不显著。护理提供网络的碎片化与持久性VAD植入后更高的院内感染率和90天感染率相关。这些网络可以作为新的目标，患者接受VAD植入。该分析评估了医院护理提供网络碎片化与住院和90天结局之间的关系。这些网络可能是改善结果的新目标。
To examine whether fragmentation of care is associated with worse in-hospital and 90-day outcomes following durable ventricular assist device (VAD) implant. Cohort Study This study was conducted using Medicare claims linked to the Society of Thoracic Surgeons (STS) Interagency Registry for Mechanically Assisted Circulatory Support (Intermacs) among patients undergoing VAD implant between July 2009 and April 2017. Medicare data were used to measure fragmentation of the multidisciplinary care delivery network for the treating hospital, based on providers’ history of shared patients within the previous year. STS Intermacs data were used for risk adjustment and outcomes ascertainment. Hospitals were sorted into terciles based on the degree of network fragmentation, measured as the mean number of links separating providers in the network. Multivariable regression was used to associate network fragmentation with 90-day death or infection risk. The cohort included 5159 patients who underwent VAD implant, with 11.2% dying and 27.6% experiencing an infection within 90 days after implant. After adjustment, a 1-unit increase in network fragmentation was associated with an increase of 0.179 in the probability of in-hospital infection and an increase of 0.183 in the probability of 90-day infection (both P < .05). Similar results were observed in models of the numbers of in-hospital and 90-day infections. Network fragmentation was predictive of the probability of 90-day mortality, although this relationship was not significant after adjustment. Care delivery network fragmentation is associated with higher in-hospital and 90-day infection rates following durable VAD implant. These networks may serve as novel targets for patients undergoing VAD implant. This analysis evaluates the relationship between hospital care delivery network fragmentation and in-hospital and 90-day outcomes. These networks may be novel targets for improving outcomes.
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作者：
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