The structure and outcomes of critical care transfer network

描述(由申请人提供)： 对危重病人的护理是美国医学中常见、昂贵且不断增长的一部分。一些医院为这些患者提供比其他医院更高质量的护理。每年约有10,000名患者死于急性心肌梗死，如果他们在更好的医院，他们本可以获救。同样，在机械通风后，大量患者死亡，可能是可以避免的死亡。鉴于不同医院在医疗质量上的巨大差异，人们越来越有兴趣开发一种正式的系统，将患者转移到更高质量的医院。虽然有人呼吁建立一个正式的病人转移系统，但一个计划外的系统已经演变成用于危重病人的转移。我们知道重症监护转运很常见，但我们对转运的网络知之甚少。特别是，我们不知道该网络是否将患者引导到更高质量的医院。这一提议的全球假设是，重症监护转移网络是一个连贯的结构，而不仅仅是随机过程的聚集。我们假设，这种结构与医院的组织特征直接相关，影响患者的预后，并易于干预。我们将实现三个具体目标。首先，我们将绘制并表征网络结构。其次，我们将研究医院在网络中的中心地位--即网络将患者推向医院的程度--与医院组织特征和能力之间的关联。第三，我们将确定医院网络中心性与患者预后之间的关系：我们将使用急性心肌梗死这一最常见的疾病过程之一后30天的死亡率作为我们的模型系统。该项目的数据将主要来自联邦医疗保险索赔。这项研究直接关系到为急性疾病患者提供高质量护理的目标，特别是急性心肺紊乱。这项提案调查了现有的重症护理转运网络是否可以作为基础，通过将患者转移到提供更好护理的医院来改善对患者的护理。(摘要结束)

DESCRIPTION (provided by applicant): The care "of critically ill patients is a common, expensive, and growing part of American medicine. Some hospitals provide higher quality care to these patients than do other hospitals. Every year approximately 10,000 patients die from acute myocardial infarction who might have been saved had they been at a higher performing hospital. Similarly large numbers of patients die potentially avoidable deaths after mechanical ventilation. Given these large variations between hospitals in the quality of their care, there is growing interest in developing a formal system to transfer patients to higher quality hospitals. While there are calls for a formal system for transferring patients, an unplanned system has already evolved for the transfer of critically ill patients. We know critical care transfers are common, but we know very little abput the network over which they are transferred. In particular, we do not know whether the network directs patients towards higher quality hospitals. The global hypothesis of this proposal is that the critical care transfer network is a coherent structure, not just an aggregation of random processes. This structure, we hypothesize, is directly related to hospital organizational characteristics, impacts patient outcomes, and is amenable to intervention. We will perform three Specific Aims. First, we will map and characterize the network structure. Second, we will examine the association between a hospital's centrality in the network - that is, the degree to which the network moves patients towards to the hospital - and hospital organizational characteristics and capabilities. Third, we will determine the relationship between a hospital's network centrality and outcomes of its patients: We will use as our model system 30-day mortality after one of the most common disease processes requiring critical care: acute myocardial infarction. Data for this project will be derived primarily from the Medicare claims. This research is directly relevant to the goal of providing high quality care to patients with acute illness, particularly acute cardiac and pulmonary derangements. This proposal investigates whether the existing network of critical care transfers can be used as a foundation to improve the care of patients by moving patients to hospitals that provide better care. (End of Abstract)