Sayeh Nikpay

Patients' needs are sometimes mismatched to facility capabilities and thus patients may not receive guideline concordant care in a timely manner. Interfacility transfer networks (IfTNs) move patients from hospitals with fewer capabilities to hospitals that are able to provide guideline concordant care for acute conditions such as trauma, heart attack, and stroke. Regionalized IfTNs are organized groups of hospitals that agree in advance to transfer patients in such a way that time from symptom onset to treatment is minimized. These networks have been shown to lower mortality and improve quality of care. 

Although there are some well-known examples of regionalized IfTNs for STEMI, trauma, and stroke, the extent to which IfTNs are regionalized across the country is unknown. National, systematic data on regionalization are unavailable and conducting a comprehensive survey of networks across the U.S. would be infeasible: treatment guidelines as well as hospital treatment capabilities and system affiliation change over time, making networks dynamic. These researchers propose a novel solution: use network analysis and community detection to identify and characterize naturally occurring IfTNs using medical claims representing 12% of the U.S. population in 2019. They then characterize the extent that the identified IfTNs resemble a regionalized organization.

Previous work on IfTNs has focused on a selected set of conditions with a concerted effort to achieve regionalization. These include trauma, STEMI, and more recently conditions such as stroke. In each of these conditions, time to treatment is thought to be an important determinant of outcomes and thus organizing transfers around selected, geographically proximate hospitals should, in theory, reduce mortality. Studies of trauma networks find. Studies of selected STEMI IfTNs organized by the American Heart Association's MissionLifeline program found that regionalization was associated with a reductions in mortality, potentially due to a drop in time to receiving guideline concordant care.

Across these studies, regionalization is measured in one of two ways - using the introduction of support for establishing an IfTN from organizations such as the American Heart Association or a particular state, or using surveys of county EMS agencies, which may serve in a coordination role. Although these approaches can provide information on regionalization in a particular place and time, it cannot capture the extent of regionalization across the U.S., over time. Furthermore, these efforts capture the intent to regionalize, but cannot capture whether transfer patterns within the regionalized network follow idealized patterns or persist over time. Furthermore, understanding the structure of IfTNs, even ones that are not regionalized, is important to patient outcomes and access to care.  

These researchers use method to discover “naturally occurring” IfTNs using large administrative datasets to identify interfacility transfers and infer from the pattern of transfers the set of hospitals that are most likely to exclusively share patients. Specifically, they are applying network analysis and community detection to 100% inpatient and outpatient traditional Medicare claims.