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. 2022 Dec 1;28(12):e444-e451.
doi: 10.37765/ajmc.2022.89280.

Care fragmentation predicts 90-day durable ventricular assist device outcomes

Russell J Funk  1 , Francis D Pagani, Hechuan Hou, Min Zhang, Guangyu Yang, Preeti N Malani, P Paul Chandanabhumma, Lourdes Cabrera, K Dennie Kim, Donald S Likosky; Michigan Congestive Heart Failure Investigators
Affiliations

Care fragmentation predicts 90-day durable ventricular assist device outcomes

Russell J Funk et al. Am J Manag Care. .

Abstract

Objectives: To examine whether fragmentation of care is associated with worse in-hospital and 90-day outcomes following durable ventricular assist device (VAD) implant.

Study design: Cohort study.

Methods: This study was conducted using Medicare claims linked to the Society of Thoracic Surgeons (STS) Interagency Registry for Mechanically Assisted Circulatory Support (Intermacs) among patients undergoing VAD implant between July 2009 and April 2017. Medicare data were used to measure fragmentation of the multidisciplinary care delivery network for the treating hospital, based on providers' history of shared patients within the previous year. STS Intermacs data were used for risk adjustment and outcomes ascertainment. Hospitals were sorted into terciles based on the degree of network fragmentation, measured as the mean number of links separating providers in the network. Multivariable regression was used to associate network fragmentation with 90-day death or infection risk.

Results: The cohort included 5159 patients who underwent VAD implant, with 11.2% dying and 27.6% experiencing an infection within 90 days after implant. After adjustment, a 1-unit increase in network fragmentation was associated with an increase of 0.179 in the probability of in-hospital infection and an increase of 0.183 in the probability of 90-day infection (both P < .05). Similar results were observed in models of the numbers of in-hospital and 90-day infections. Network fragmentation was predictive of the probability of 90-day mortality, although this relationship was not significant after adjustment.

Conclusions: Care delivery network fragmentation is associated with higher in-hospital and 90-day infection rates following durable VAD implant. These networks may serve as novel targets for enhancing outcomes for patients undergoing VAD implant.

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Figures

Figure 1:
Figure 1:
Changes in Care Delivery Network Fragmentation over time by tercilea aChanges in care delivery network fragmentation by year, stratified by network tercile.
Figure 2:
Figure 2:
Associations between Care Delivery Network Fragmentation among VAD Team Members and In-hospital and 90-day Patient Outcomesa aIn each figure, each circle represents a binned set of hospitals. X-axis: care delivery network fragmentation; Y-axis: the probability of each outcome based on multivariable regression models.
See this image and copyright information in PMC

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