Catholic University of the Sacred Heart, Department of Public Health and Graduate School of Health Economics and Management, Largo F. Vito 1, 00168 Rome, Italy.
Maastricht University, School for Public Health and Primary Care (CAPHRI), Department of Health Services Research, The Netherlands.
Soc Sci Med. 2015 May;132:113-21. doi: 10.1016/j.socscimed.2015.03.029. Epub 2015 Mar 14.
Previous studies have shown that referral networks encompass important mechanisms of coordination and integration among hospitals, which enhance numerous organizational-level benefits, such as productivity, efficiency, and quality of care. The present study advances previous research by demonstrating how hospital referral networks influence patient readmissions. Data include 360,697 hospitalization events within a regional community of hospitals in the Italian National Health Service. Multilevel hierarchical regression analysis tests the impacts of referral networks' structural characteristics on patient hospital readmissions. The results demonstrate that organizational centrality in the overall referral network and ego-network density have opposing effects on the likelihood of readmission events within hospitals; greater centrality is negatively associated with readmissions, whereas greater ego-network density increases the likelihood of readmission events. Our findings support the (re)organization of healthcare systems and provide important indications for policymakers and practitioners.
先前的研究表明，转诊网络包含了医院之间协调和整合的重要机制，这提高了众多组织层面的效益，如生产力、效率和医疗质量。本研究通过展示医院转诊网络如何影响患者再入院，推进了先前的研究。数据包括意大利国家卫生服务体系中一个地区性医院社区内的 360697 例住院事件。多层次层次回归分析测试了转诊网络结构特征对患者医院再入院的影响。结果表明，在整体转诊网络和自我网络密度中的组织中心度对医院内再入院事件的可能性有相反的影响；更大的中心度与再入院呈负相关，而更大的自我网络密度则增加了再入院事件的可能性。我们的研究结果支持（重新）组织医疗保健系统，并为政策制定者和从业者提供了重要的指示。
