Unnikrishnan K P, Patnaik Debprakash, Iwashyna Theodore J
University of Michigan, Ann Arbor, MI 48109,
AMIA Jt Summits Transl Sci Proc. 2011;2011:74-8. Epub 2011 Mar 7.
Most Americans are in Intensive Care Units (ICUs) at some point during their lives. There is wide variation in the outcome quality of ICUs and so, thousands of patients who die each year in ICUs may have survived if they were at the appropriate hospital. In spite of a policy agenda from IOM calling for effective transfer of patients to more capable hospitals to improve outcomes, there appear to be substantial inefficiencies in the existing system. In particular, patients recurrently transfer to secondary hospitals rather than to a most-preferred option. We present data mining schemes and significance tests to discover these inefficient cascades. We analyze critical care transfer data in Medicare across nearly 5,000 hospitals in the United States over 10 years and present evidence that these transfers to secondary hospitals repeatedly cascade across multiple transfers, and that some hospitals seem to be involved in many cascades.
大多数美国人在其一生中的某个时候会住进重症监护病房（ICU）。各ICU的治疗结果质量差异很大，因此，如果在合适的医院接受治疗，每年在ICU死亡的数千名患者可能会存活下来。尽管美国医学研究所（IOM）提出了一项政策议程，呼吁将患者有效转至更有能力的医院以改善治疗结果，但现有系统似乎存在严重的低效问题。特别是，患者经常转至二级医院，而不是最理想的医院。我们提出数据挖掘方案和显著性检验来发现这些低效的级联转移。我们分析了美国近5000家医院10年间医疗保险中的重症监护转移数据，并提供证据表明，这些转至二级医院的情况会多次反复进行级联转移，而且一些医院似乎参与了许多级联转移。
