Interaction patterns of trauma providers are associated with length of stay
Interaction patterns of trauma providers are associated with length of stay
复制标题
DOI：
10.1093/jamia/ocy009
复制
发表时间：
2018-07-01
影响因子：
6.4
通讯作者：
Malin, Bradley A.
中科院分区：
文献类型：
--
作者：
Chen, You;Patel, Mayur B.;Malin, Bradley A.
背景资料：创伤相关的住院导致了很高比例的医疗保健支出和住院资源消耗，这与住院时间（LOS）直接相关。卫生保健人员之间强大而可靠的互动可以减少LOS。然而，有很少知道某些模式的相互作用是否存在，以及它们如何与服务水平及其变化。本研究的目的是了解互动模式和量化的关系，LOS在一个成熟的创伤系统和长期的电子病历（EMR）。方法：我们采用了频谱共聚类方法来推断的互动模式的基础上，5588住院成人创伤幸存者的EMR的卫生保健员工。交互模式和LOS之间的关系进行了评估，通过负二项回归模型。我们进一步评估了潜在的混杂因素的影响，年龄，医疗保健遇到的日期，数量的访问行动类型的保健提供者致力于病人的电子病历，一个月的入院，全表型关联研究代码，程序代码，和保险status.Results：三种类型的相互作用模式被发现。第一种模式表现出员工之间的合作最多，并与最短的LOS。与此模式相比，第二和第三模式的LOS分别长0.61天（P = 0.014）和0.43天（P = 0.037）。虽然3个互动模式处理不同数量的患者在每个入院月，我们的研究结果表明，护理提供了类似patients.Discussion：本研究的结果表明，有一个LOS之间的关联和程度的医疗保健员工在护理受伤的病人。研究结果进一步表明，有价值的确定这些相互作用的内容和因素，引起这些差异的互动模式内的创伤系统。
Background: Trauma-related hospitalizations drive a high percentage of health care expenditure and inpatient resource consumption, which is directly related to length of stay (LOS). Robust and reliable interactions among health care employees can reduce LOS. However, there is little known about whether certain patterns of interactions exist and how they relate to LOS and its variability. The objective of this study is to learn interaction patterns and quantify the relationship to LOS within a mature trauma system and long-standing electronic medical record (EMR).Methods: We adapted a spectral co-clustering methodology to infer the interaction patterns of health care employees based on the EMR of 5588 hospitalized adult trauma survivors. The relationship between interaction patterns and LOS was assessed via a negative binomial regression model. We further assessed the influence of potential confounders by age, number of health care encounters to date, number of access action types care providers committed to patient EMRs, month of admission, phenome-wide association study codes, procedure codes, and insurance status.Results: Three types of interaction patterns were discovered. The first pattern exhibited the most collaboration between employees and was associated with the shortest LOS. Compared to this pattern, LOS for the second and third patterns was 0.61 days (P = 0.014) and 0.43 days (P = 0.037) longer, respectively. Although the 3 interaction patterns dealt with different numbers of patients in each admission month, our results suggest that care was provided for similar patients.Discussion: The results of this study indicate there is an association between LOS and the extent to which health care employees interact in the care of an injured patient. The findings further suggest that there is merit in ascertaining the content of these interactions and the factors that induce these differences in interaction patterns within a trauma system.