Key result
Internal referral for elective CABG was associated with shorter median hospital stays (7 days; p<0.01) compared to external referral, with comparable clinical outcomes and quality of life.
Why the study?
The study was conducted to compare clinical outcomes, quality of life, and process parameters of CABG patients treated across different referral pathways in a regional hub-and-spokes network.
Do different referral pathways in a hub-and-spoke network affect clinical outcomes, quality of life, and process parameters in elective CABG patients?
Cohort (n=690)
Yes
Do different referral pathways in a hub-and-spoke network affect clinical outcomes, quality of life, and process parameters in elective CABG patients?
Different referral pathways in a hub-and-spoke model for CABG patients show variations in process parameters like hospital stay and rehabilitation timing, but maintain comparable clinical outcomes and quality of life.
May support equivalent CABG outcomes across hub-spoke pathways; leaves open need for prospective validation of network efficiencies.
Objective To compare clinical outcomes, quality of life and process parameters of coronary artery bypass grafting (CABG) patients treated in a regional hub-and-spokes network.Methods Data from patients who underwent elective CABG from 2016 to 2020 at a Dutch heart center ('hub') were grouped by referral pathways by the cardiologist: internal (A) and four external (B–E). Clinical outcomes, quality of life, and process parameters were evaluated.Results In 690 CABG patients, no significant differences in baseline characteristics and clinical outcomes between care pathways were revealed. Hub-treated patients had shorter median hospital (7 days, IQR 6–8; p<.01) and preoperative stays (1 day, IQR 1–1; p<.01) compared to those treated at spokes. Within 8 weeks, 97.2% had outpatient visits, with pathways A, C, and E attending more frequently than B and D. Time to first visit ranged from 31–44 days. Cardiac rehabilitation began at 6 weeks for 40.4% of patients, with higher rates in Pathways B and D (66.4% and 50.0%) compared to the hub, C, and E (27.2% and 33.7%; p<0.001).Conclusion The study revealed notable variations in process parameters among different care pathways within a hub-and-spoke model for CABG patients, while maintaining comparable clinical outcomes and quality of life.
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Steenbergen et al. (2024) conducted a cohort in Coronary artery bypass grafting (CABG) (n=690). Internal referral pathway (hub) vs. External referral pathways (spokes) was evaluated on Median hospital stay (p=<0.01). Internal referral for elective CABG was associated with shorter median hospital stays (7 days; p<0.01) compared to external referral, with comparable clinical outcomes and quality of life.
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