Assessing Neonatal Intensive Care Unit Structures and Outcomes Before and During the COVID-19 Pandemic: Network Analysis Study.
Assessing Neonatal Intensive Care Unit Structures and Outcomes Before and During the COVID-19 Pandemic: Network Analysis Study.
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DOI：
10.2196/27261
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发表时间：
2021-10-20
影响因子：
7.4
通讯作者：
Chen Y
中科院分区：
文献类型：
--
作者：
Mannering H;Yan C;Gong Y;Alrifai MW;France D;Chen Y
卫生保健组织（HCO）采取战略（例如，物理距离），以在COVID-19大流行期间保护重症监护室（ICU）的临床医生和患者。许多在COVID-19大流行前实际进行的护理活动已于大流行期间过渡至虚拟系统。这些转变可能会干扰ICU的协作结构，从而影响临床结果。了解这些差异可以帮助HCO在后COVID-19时代将物理协作过渡到虚拟环境时识别挑战。本研究旨在利用网络分析来确定新生儿重症监护室（NICU）协作结构从COVID-19前到内的变化。本回顾性研究应用网路分析法，分析712位新生儿重症病例电子健康档案之利用情况（COVID-19前，n=386; 2019年9月1日至2020年6月30日期间在范德比尔特大学医学中心NICU住院的患者（n=326，不包括COVID-19患者），以评估临床医生之间的合作。我们将2019冠状病毒病疫情前的期间界定为2019年9月至12月期间，并将2019冠状病毒病疫情期间界定为2020年3月至6月期间。根据患者的临床特征，包括年龄、性别、种族、住院时间（LOS）和出院处置，对这两组进行比较。我们利用致力于患者EHR的临床医生的行动来衡量临床医生与临床医生之间的联系。我们将2名临床医生之间的合作关系（关系）描述为在同一天内对同一患者进行EHR。在定义合作关系方面，我们建立了COVID-19前和COVID-19内的网络。我们使用了3个社会计量学测量，包括特征向量中心性，偏心率和介数，分别量化临床医生的领导力，协作难度和网络中的广泛技能。我们使用Mann-Whitney U检验（95%CI）评估了2个网络中临床医生的特征向量中心性、偏心率和介数的统计学差异程度。从COVID-19爆发前到爆发期间，协作难度有所增加（偏心率中位数：3 vs 4; P<.001）。护士的领导能力下降（特征向量中心性中位数：0.183 vs 0.087; P<.001），在流感大流行期间，具有更广泛技能的产科医生在NICU结构中照顾更多的患者（介数中心性中位数：0.0001 vs 0.005; P<.001）。COVID-19前和COVID-19内患者组在性别（差异约为0）、种族（白色差异为4%，非裔美国人差异为3%）、LOS（1.5天内的四分位距差异）和出院处置（家中差异约为0，死亡差异为2%，其他差异为2%）方面具有相似的分布。两组之间的患者人口统计学和结局无显著差异。NICU收治患者的管理通常需要多学科护理团队。了解协作结构可以提供细粒度的证据，以潜在地改进或优化NICU中现有的团队合作。
Health care organizations (HCOs) adopt strategies (eg. physical distancing) to protect clinicians and patients in intensive care units (ICUs) during the COVID-19 pandemic. Many care activities physically performed before the COVID-19 pandemic have transitioned to virtual systems during the pandemic. These transitions can interfere with collaboration structures in the ICU, which may impact clinical outcomes. Understanding the differences can help HCOs identify challenges when transitioning physical collaboration to the virtual setting in the post–COVID-19 era. This study aims to leverage network analysis to determine the changes in neonatal ICU (NICU) collaboration structures from the pre– to the intra–COVID-19 era. In this retrospective study, we applied network analysis to the utilization of electronic health records (EHRs) of 712 critically ill neonates (pre–COVID-19, n=386; intra–COVID-19, n=326, excluding those with COVID-19) admitted to the NICU of Vanderbilt University Medical Center between September 1, 2019, and June 30, 2020, to assess collaboration between clinicians. We characterized pre–COVID-19 as the period of September-December 2019 and intra–COVID-19 as the period of March-June 2020. These 2 groups were compared using patients’ clinical characteristics, including age, sex, race, length of stay (LOS), and discharge dispositions. We leveraged the clinicians’ actions committed to the patients’ EHRs to measure clinician-clinician connections. We characterized a collaboration relationship (tie) between 2 clinicians as actioning EHRs of the same patient within the same day. On defining collaboration relationship, we built pre– and intra–COVID-19 networks. We used 3 sociometric measurements, including eigenvector centrality, eccentricity, and betweenness, to quantify a clinician’s leadership, collaboration difficulty, and broad skill sets in a network, respectively. We assessed the extent to which the eigenvector centrality, eccentricity, and betweenness of clinicians in the 2 networks are statistically different, using Mann-Whitney U tests (95% CI). Collaboration difficulty increased from the pre– to intra–COVID-19 periods (median eccentricity: 3 vs 4; P<.001). Nurses had reduced leadership (median eigenvector centrality: 0.183 vs 0.087; P<.001), and neonatologists with broader skill sets cared for more patients in the NICU structure during the pandemic (median betweenness centrality: 0.0001 vs 0.005; P<.001). The pre– and intra–COVID-19 patient groups shared similar distributions in sex (~0 difference), race (4% difference in White, and 3% difference in African American), LOS (interquartile range difference in 1.5 days), and discharge dispositions (~0 difference in home, 2% difference in expired, and 2% difference in others). There were no significant differences in the patient demographics and outcomes between the 2 groups. Management of NICU-admitted patients typically requires multidisciplinary care teams. Understanding collaboration structures can provide fine-grained evidence to potentially refine or optimize existing teamwork in the NICU.
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DOI：
10.1093/jamia/ocy009
发表时间：
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影响因子：
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作者：
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