Assessing Intrahospital Care Transition Structures Before and During the COVID-19 Pandemic: Network Analysis Study

Transitions of care (TOC) is essential for patients with complex medical needs to maintain the continuity of care. The COVID-19 pandemic may result in unexpected pressure on healthcare organizations' routine work and may burden the TOC system. The objective of this study is to assess TOC structures in pre- and intra-COVID-19 and quantify changes in the structures through the lens of network analysis. We investigated a trauma registry repository consisting of care transitions of 5,674 (2,699 and 2,975 in pre- and intra-COVID-19) inpatients admitted to Vanderbilt University Medical Center (VUMC) between January 2019 and May 2021. Network metrics, including assortativity, homophily, and small-world-ness were leveraged to measure TOC structures and their changes. Our results showed both pre- and intra-COVID-19 TOC structures were disassortative, homophily, and small-world- ness, and the COVID-19 pandemic had limited influences on the three characteristics of the TOC structures. The disassortative TOC structure indicates patients can be efficiently transferred between triage centers (highly connected units) and receivers (lowly connected units); the homophily structure demonstrates two connected care units serve similar patients, and the small-world-ness reveals a patient can be transferred to highly collaborative care units with a short length of transfer path.