Uncharted Paths: Hospital Networks in Critical Care

Wide variation between hospitals in the quality of critical care lead to many potentially avoidable deaths. Regionalization of critical care is a possible solution; regionalization has been implemented for trauma and neonatal intensive care, and it is under active discussion for medical and cardiac critical care. However, regionalization is only one possible approach to reorganizing critical care services. This commentary introduces the technique of network analysis as a framework for the following: (1) understanding how critically ill patients move between hospitals, (2) defining the roles hospitals play in regional care delivery, and (3) suggesting systematic improvements that may benefit population health. We examined transfers of critically ill Medicare patients in Connecticut in 2005 as a model system. We found that patients are systematically transferred to more capable hospitals. However, we find the standard distinction of hospitals into either “secondary hospitals” or “tertiary hospitals” poorly explains observed transfer patterns; instead, hospitals show a continuum of roles. We further examine the implications of the network pattern in a simulation of quarantine of a hospital to incoming transfers, as occurred during the severe acute respiratory syndrome epidemic. Network perspectives offer new ways to study systems to care for critically ill patients and provide additional tools for addressing pragmatic problems in triage and bed management, regionalization, quality improvement, and disaster preparedness. (CHEST 2009; 135:827– 833)his analysis was supported in part by a Fellows Career Development Award from the American Thoracic Society, National Institutes of Health (NIH)/National Heart, Lung, and Blood Institute (NHLBI) Cardiopulmonary Epidemiology Training Grant No. 5T32HL007891 and NIH/NHLBI No. 1K08HL091249-01.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/61909/1/09.I.Christie.Asch.Kahn.09.Chest.pd

Historical sketch of Vassar college.: Founded at Poughkeepsie, N.Y., January 18, 1861 .../ Prepared in compliance with an invitation from the Commission of the Bureau of Education, representing the Department of the Interior in matters relating to the National centennial of 1876. _

1 p. L., 54 p. : ill. ; 30 cm."Prepared in compliance with an invitation from the commission of the Bureau of education, representing the Department of the interior in matters relating to the National centennial of 1876."Electronic text and image data. Ann Arbor, Mich. : University of Michigan, Digital Library Initiatives, 1996. Includes both TIFF files and keyword searchable text. [Making of America] This volume is made possible by a grant from the Andrew W. Mellon Foundation

Historical sketch of Vassar college. [electronic resource] Founded at Poughkeepsie, N.Y., January 18, 1861 .../

"Prepared in compliance with an invitation from the commission of the Bureau of education, representing the Department of the interior in matters relating to the National centennial of 1876."Electronic text and image data.Mode of access: Internet

Annual catalogue.

Title varies slightly.Mode of access: Internet

A list of the printers' marks in the windows of the Frederick Ferris Thompson Memorial Library, Vassar College.

Bibliography: p. 8.Mode of access: Internet

Dutchess county goes to market, adapted from a project of the Vassar social museum,

Mode of access: Internet

Publications of the Folk-Lore Foundation /

Title from cover.Mode of access: Internet

Photograph of David Herbert Donald

Portrait of Donald at approximately 40 years old