161 Importance of Hospital Centrality Analysis in Brain Metastasis

Abstract

INTRODUCTION: Management of patients with brain metastasis (BrM) is complex and interdisciplinary, with patients transitioning between distinct hospitals within an interconnected network at different points of their disease. Prior neurosurgical health delivery quality studies often analyze hospitals in isolation, negating the complexities of patient journey. A facility’s position in an integrated clinical network may therefore play a critical consideration in patient management and outcomes. METHODS: We selected BrM patients using ICD codes from the Healthcare Cost and Utilization Project (HCUP) inpatient and emergency department databases from Massachusetts (2018-2019). Hospitals were separated into quartiles based on connectivity, defined as sum of all weighted ties to other hospitals in MA. We compared patient and hospital characteristics across connectivity quartiles and determined impact of hospital connectivity on all-cause mortality, readmission rates, and length of stay using multivariate regression. RESULTS: A total of 4679 BrM patients were mapped across MA. While highly connected hospitals were on average larger than peripheral hospitals (p < 0.001), many highly connected hospitals had a low number of patient beds. Patients who visit highly connected hospitals were more likely to live in large metropolitan areas and higher income neighborhoods, and be covered by private insurance (all p < 0.001). Comorbidity scores and age were not meaningfully different between hospitals of varying connectivity scores. Hospital centrality, but not hospital volume, was inversely associated with mortality and readmissions rate, with highly connected hospitals having a lower risk of death (Q1: 2.4 (1.46-3.83); Q2: 1.6 (1.07-2.29); Q3: 1.4 (1.11-1.86); Q4 (ref)). CONCLUSIONS: We demonstrate a vital role for hospital connectedness in impacting BrM patient outcome, independent of hospital volume and patient characteristics. Structural barriers, such as insurance or patient residence, may impede patients from receiving care at highly connected hospitals.