Enhancing structural resilience in healthcare through patient flow network

TL;DR

This study analyzes how cross-regional patient flow networks in the U.S. healthcare system improved resilience during COVID-19 by redistributing patient demand, highlighting the importance of regional coordination in disaster response.

Contribution

It introduces a novel analysis of billions of medical records to map patient flow networks and quantifies how regional coordination enhances healthcare resilience during crises.

Findings

Cross-regional patient flow increased from 3.53% to 4.59% during COVID-19.

Redistribution absorbed 63% of excess facility stress, reducing clinician demand.

Strengthening patient flow networks could further improve system resilience.

Abstract

Large-scale disasters, such as pandemics and climate-related events, test the resilience of healthcare systems, that is, their ability to ensure patient care under extreme strain. These crises intensify stress on the system, meaning sudden surges in demand for hospital beds, staff, and critical supplies, while increasing pressure on clinicians and other frontline providers. Most existing studies measure resilience using broad, system-wide outcomes, but often overlook how coordination between regions helps manage stress and keep care accessible. In this study, we analyzed billions of electronic medical records to construct cross-regional patient flow networks in the U.S., mapping how patients moved across healthcare facilities. During the COVID-19 pandemic, we observed that cross-regional flow rose to 4.59%, compared to the pre-pandemic level of 3.53%. This redistribution absorbed, on average, 63% of the excess stress on facilities, meaning nearly two-thirds of surging demand was handled by shifting patients to less burdened regions, an absolute 32 percentage point improvement from the pre-pandemic baseline of 31%. Further analysis suggests that strengthening cross-regional coordination could allow the healthcare system to absorb even more stress, reduce clinicians' demand, and reduce excess deaths. These findings show that structural strategies, like reinforcing patient flow between regions, can substantially enhance resilience, providing critical insights for future pandemic preparedness and disaster response planning, and ultimately improving patient care.