Impact of transfer status on hospitalization cost and discharge disposition for acute ischemic stroke across the US

Abstract

OBJECT In this study, the authors used information provided in the Nationwide Inpatient Sample (NIS) to study the impact of transferring stroke patients from one facility to a center where they received some form of active stroke intervention (intravenous tissue plasminogen activator, thrombectomy, or a combination of both therapies). METHODS Patient demographic characteristics and hospital factors obtained from the 2008–2010 acute stroke NIS data were analyzed. Discharge disposition, hospitalization cost, and mortality were the dependent variables studied. Univariate analysis and multivariate binary logistic regression analysis were performed. Data analysis focused on the cohort of acute stroke patients who received some form of active intervention (55,913 of 1,311,511 patients in the NIS). RESULTS When overall outcome was considered, transferred patients had a significantly higher number of other-than-routine (OTR, i.e., other than discharge to home without home health care) discharge dispositions (p < 0.0001). In multivariate regression analysis including pertinent patient and hospital factors, transfer-in patients had significantly worse OTR discharge disposition (p < 0.0001, odds ratio [OR] 2.575, 95% CI 2.341–2.832). Mean hospitalization cost including an intervention was $70,325.11 for direct admissions and $97,546.92 for transferred patients. Transfer from another facility (p < 0.001, OR 1.677, 95% CI 1.548–1.817) was associated with higher hospitalization cost. CONCLUSIONS The study showed that hospital cost for acute stroke intervention is significantly higher for a transferred patient than for a direct admission. Moreover, the frequency of OTR discharge was significantly higher among transferred patients than direct admissions. Future strategies should focus on ways and means of transporting patients appropriately and directly to stroke centers.

Academic impact and rankings of neuroendovascular fellowship programs across the United States

“…A recent study has shown that the direct admission of patients to a comprehensive stroke center (as opposed to the transfer of patients from another facility to such a center) is associated with better outcomes and lower hospitalization costs. 11 The present study showed that departments affiliated with a JC-or DNV-certified stroke center did not have a significantly higher number of neuroendovascular faculty members (p = 0.417). The small number of nonaffiliated centers (7 of 37 centers) may explain the lack of significance.…”

Predictors of false-positive stroke thrombectomy transfers

“…Furthermore, patient transfers for potential thrombectomy have considerable costs, which include, but are not limited to, ambulance/helicopter services, call-pay for the neuroendovascular and stroke neurology team, repeat imaging, and a temporary suspension of what all members of the team are doing to await patient arrival 6. Sonig et al 7 evaluated 1 311 511 National Inpatient Sample stroke admissions from 2008 to 2010 and found that each transferred patient undergoing tissue plasminogen activator (tPA) and thrombectomy had a mean expenditure of $27 000 more than those who were not transferred. Thus, despite the potential to incur significant unnecessary costs, the decision to transfer is currently based on an oblique measure of a LVO.…”

Timing of vessel imaging for suspected large vessel occlusions does not affect groin puncture time in transfer patients with stroke

“…Studies have demonstrated that rapid transfer of patients with acute stroke to neurointerventional centers for thrombectomy is feasible 1 2. Research also suggests that the mean cost of hospitalization for patients transferred for IV tPA, ET, or both, is higher than those directly admitted for the same interventions 3. Although it is well established that shorter door to groin puncture times result in better outcomes for patients with stroke, there is no universally agreed transfer protocol.…”