TY - JOUR AU - Mannering, Hannah AU - Yan, Chao AU - Gong, Yang AU - Alrifai, Mhd Wael AU -法国，Daniel AU - Chen, You PY - 2021 DA - 2011/10/20 TI -评估COVID-19大流行之前和期间新生儿重症监护病房的结构和结果:网络分析研究JO - J Med Internet Res SP - e27261 VL - 23 IS - 10kw -新生儿重症监护病房KW -协作KW -卫生保健组织结构KW -重症监护KW -住院时间KW -出院配置KW -电子健康记录KW -网络分析KW - COVID-19 KW -时间网络分析AB -背景:卫生保健组织(HCOs)采用策略(如:保持身体距离)，以在COVID-19大流行期间保护重症监护病房(ICUs)的临床医生和患者。许多在COVID-19大流行前进行的实际护理活动在大流行期间已过渡到虚拟系统。这些转变可能会干扰ICU的协作结构，从而影响临床结果。理解这些差异可以帮助HCOs在后covid -19时代将实体协作过渡到虚拟环境时识别挑战。目的:本研究旨在利用网络分析方法确定新生儿重症监护病房(NICU)合作结构从新冠肺炎疫情前到新冠肺炎疫情内的变化。方法:在这项回顾性研究中，我们将网络分析应用于712例危重新生儿(covid -19前，n=386;2019年9月1日至2020年6月30日期间，在范德比尔特大学医学中心新生儿重症监护室住院的新冠肺炎患者(n=326例，不包括新冠肺炎患者)，以评估临床医生之间的合作。我们将covid -19前时期定义为2019年9月至12月，将covid -19内时期定义为2020年3月至6月。 These 2 groups were compared using patients’ clinical characteristics, including age, sex, race, length of stay (LOS), and discharge dispositions. We leveraged the clinicians’ actions committed to the patients’ EHRs to measure clinician-clinician connections. We characterized a collaboration relationship (tie) between 2 clinicians as actioning EHRs of the same patient within the same day. On defining collaboration relationship, we built pre– and intra–COVID-19 networks. We used 3 sociometric measurements, including eigenvector centrality, eccentricity, and betweenness, to quantify a clinician’s leadership, collaboration difficulty, and broad skill sets in a network, respectively. We assessed the extent to which the eigenvector centrality, eccentricity, and betweenness of clinicians in the 2 networks are statistically different, using Mann-Whitney U tests (95% CI). Results: Collaboration difficulty increased from the pre– to intra–COVID-19 periods (median eccentricity: 3 vs 4; P<.001). Nurses had reduced leadership (median eigenvector centrality: 0.183 vs 0.087; P<.001), and neonatologists with broader skill sets cared for more patients in the NICU structure during the pandemic (median betweenness centrality: 0.0001 vs 0.005; P<.001). The pre– and intra–COVID-19 patient groups shared similar distributions in sex (~0 difference), race (4% difference in White, and 3% difference in African American), LOS (interquartile range difference in 1.5 days), and discharge dispositions (~0 difference in home, 2% difference in expired, and 2% difference in others). There were no significant differences in the patient demographics and outcomes between the 2 groups. Conclusions: Management of NICU-admitted patients typically requires multidisciplinary care teams. Understanding collaboration structures can provide fine-grained evidence to potentially refine or optimize existing teamwork in the NICU. SN - 1438-8871 UR - //www.mybigtv.com/2021/10/e27261 UR - https://doi.org/10.2196/27261 UR - http://www.ncbi.nlm.nih.gov/pubmed/34637393 DO - 10.2196/27261 ID - info:doi/10.2196/27261 ER -