Abstract
Objective
Regionalized care reduces neonatal morbidity and mortality. This study evaluated the association of patient characteristics with quantitative differences in neonatal transport networks.
Study design
We retrospectively analyzed prospectively collected data for infants <28 days of age acutely transported within California from 2008 to 2012. We generated graphs representing bidirectional transfers between hospitals, stratified by patient attribute, and compared standard network analysis metrics.
Result
We analyzed 34,708 acute transfers, representing 1594 unique transfer routes between 271 hospitals. Density, centralization, efficiency, and modularity differed significantly among networks drawn based on different infant attributes. Compared to term infants and to those transported for medical reasons, network metrics identify greater degrees of regionalization for preterm and surgical patients (more centralized and less dense, respectively [pā<ā0.001]).
Conclusion
Neonatal interhospital transport networks differ by patient attributes as reflected by differences in network metrics, suggesting that regionalization should be considered in the context of a multidimensional system.
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Funding
SNK was supported by Grant K08 HS025749 from the Agency for Healthcare Research and Quality. JP and DH were supported by the Stanford Maternal Child Health Research Institute (MCHRI) Grant Program.
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SNK conceptualized and designed the study, drafted the initial manuscript, and reviewed and revised the manuscript. JAFZ and JP conceptualized and designed the study, and reviewed and revised the manuscript. MZ, JR, and DH carried out the analyses, and reviewed and revised the manuscript. CSP conceptualized and designed the study, and critically reviewed the manuscript for important intellectual content. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work. Supplementary information is available at JPERās website.
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The authors declare no competing interests.
Ethical approval
The study was approved by the institutional review board at Stanford University (protocol #50047). The study was submitted to the institutional review board at Beth Israel Deaconess Medical Center and deemed not human subject research, as all analysis was performed at Stanford University.
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Kunz, S.N., Helkey, D., Zitnik, M. et al. Quantifying the variation in neonatal transport referral patterns using network analysis. J Perinatol 41, 2795ā2803 (2021). https://doi.org/10.1038/s41372-021-01091-w
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DOI: https://doi.org/10.1038/s41372-021-01091-w