美国极低出生体重儿医院间转运网络
The Interhospital Transfer Network for Very Low Birth Weight Infants in the United States
摘要：
极低出生体重儿（VLBW）需要在新生儿重症监护室进行专门护理。在美国，这些婴儿经常在医院之间转移。虽然这些新生儿转运网络在经济上和婴儿发病率和死亡率方面都很重要，但国家一级的新生儿转运模式在很大程度上是未知的。使用佛蒙特牛津网络的数据，从2015年开始，44，753例出生，2，122家医院和9，722例医院间婴儿转移，我们对美国VLBW婴儿的医院间转移网络进行了迄今为止最大的分析。大多数社区往往在不同的州至少有两家医院。为了对这些社区之间的转移模式的结构变化进行分类，我们采用了光谱测量区域化，并发现社区的区域化程度和婴儿转移率之间的关联，这是没有利用在检测社区。我们还证明了网络中心性和层次结构的既定措施，例如，PageRank中的社区范围熵或社区内的介数中心性和不同“层”的数量与我们的区域化指数弱相关，并且与婴儿转移率的指标没有显著相关。我们的研究结果表明，区域化指数捕捉了关于极低出生体重婴儿转移网络结构特性的新信息，具有表征美国新生儿护理的实际意义，并且可以更广泛地应用于在组织复杂的适应系统中集中力量的作用。
英文摘要：
Very low birth weight (VLBW) infants require specialized care in neonatal intensive care units. In the United States (U.S.), such infants frequently are transferred between hospitals. Although these neonatal transfer networks are important, both economically and for infant morbidity and mortality, the national-level pattern of neonatal transfers is largely unknown. Using data from Vermont Oxford Network on 44,753 births, 2,122 hospitals, and 9,722 inter-hospital infant transfers from 2015, we performed the largest analysis to date on the inter-hospital transfer network for VLBW infants in the U.S. We find that transfers are organized around regional communities, but that despite being largely within state boundaries, most communities often contain at least two hospitals in different states. To classify the structural variation in transfer pattern amongst these communities, we applied a spectral measure for regionalization and found an association between a community's degree of regionalization and their infant transfer rate, which was not utilized in detecting communities. We also demonstrate that the established measures of network centrality and hierarchy, e.g., the community-wide entropy in PageRank or betweenness centrality and number of distinct `layers' within a community, correlate weakly with our regionalization index and were not significantly associated with metrics on infant transfer rate. Our results suggest that the regionalization index captures novel information about the structural properties of VLBW infant transfer networks, have the practical implication of characterizing neonatal care in the U.S., and may apply more broadly to the role of centralizing forces in organizing complex adaptive systems.
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