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Comparative Study
. 2017 Jun;37(6):702-708.
doi: 10.1038/jp.2017.20. Epub 2017 Mar 23.

Network Analysis: A Novel Method for Mapping Neonatal Acute Transport Patterns in California

Free PMC article
Comparative Study

Network Analysis: A Novel Method for Mapping Neonatal Acute Transport Patterns in California

S N Kunz et al. J Perinatol. .
Free PMC article


Objective: The objectives of this study are to use network analysis to describe the pattern of neonatal transfers in California, to compare empirical sub-networks with established referral regions and to determine factors associated with transport outside the originating sub-network.

Study design: This cross-sectional database study included 6546 infants <28 days old transported within California in 2012. After generating a graph representing acute transfers between hospitals (n=6696), we used community detection techniques to identify more tightly connected sub-networks. These empirically derived sub-networks were compared with state-defined regional referral networks. Reasons for transfer between empirical sub-networks were assessed using logistic regression.

Results: Empirical sub-networks showed significant overlap with regulatory regions (P<0.001). Transfer outside the empirical sub-network was associated with major congenital anomalies (P<0.001), need for surgery (P=0.01) and insurance as the reason for transfer (P<0.001).

Conclusion: Network analysis accurately reflected empirical neonatal transfer patterns, potentially facilitating quantitative, rather than qualitative, analysis of regionalized health care delivery systems.

Conflict of interest statement

Conflict of Interest: The authors have no conflicts of interest relevant to this article to disclose.


Figure 1
Figure 1. Network graph of acute neonatal transports in California
Empirical sub-networks overlaid onto RPPC regulatory regions. Empirical sub-networks are color-coded. Node size denotes number of transports into a hospital. Node shape denotes AAP level (circles - levels 1 and 2; squares - level 3; rectangles - level 4). The black line marks the division between Kaiser Permanente Northern and Southern regions. The San Francisco and Los Angeles areas have been enlarged for clarity.

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