Quantifying the variation in neonatal transport referral patterns using network analysis

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 2008-2012. 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 1 594 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 [p<0.001]). 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 multi-dimensional system.