Interhospital Transfer and Receipt of Specialty Procedures

Abstract

The practice of transferring patients between acute care hospitals is variable and largely nonstandardized. Although often-cited reasons for transfer include providing patients access to specialty services only available at the receiving institution, little is known about whether and when patients receive such specialty care during the transfer continuum. We performed a retrospective analysis using 2013 100% Master Beneficiary Summary and Inpatient claims files from Centers for Medicare and Medicaid Services. Beneficiaries were included if they were aged =65 years, continuously enrolled in Medicare A and B, with an acute care hospitalization claim, and transferred to another acute care hospital with a primary diagnosis of acute myocardial infarction, gastrointestinal bleed, renal failure, or hip fracture/dislocation. Associated specialty procedure codes (International Classification of Diseases, Ninth Revision, Clinical Modification) were identified for each diagnosis. We performed descriptive analyses to compare receipt of specialty procedural services between transferring and receiving hospitals, stratified by diagnosis. Across the 19,613 included beneficiaries, receipt of associated specialty procedures was more common at the receiving than the transferring hospital, with the exception of patients with a diagnosis of gastrointestinal bleed. Depending on primary diagnosis, between 32.4% and 89.1% of patients did not receive any associated specialty procedure at the receiving hospital. Our results demonstrate variable receipt of specialty procedural care across the transfer continuum, implying the likelihood of alternate drivers of interhospital transfer other than solely receipt of specialty procedural care.

Predictors of Mortality among Inter-Hospital Transferred Patients in a Middle-Income Country: a Retrospective Cohort Study

“…12,24 This indicates our patients were in much less critical conditions than those in other studies. Finally, similar to findings from other studies 7,8 , the patients' profiles of our study were heterogeneous (Table 2).…”

“…2 Additional to the systemic threats, growing evidence demonstrated higher acute severity, a longer length of stay, higher hospital mortality and higher resources use in IHT patients when compared to non-IHT cases. [3][4][5][6][7] These undesirable outcomes of IHT patients could be due to heterogeneity among IHT patients depending on the diagnosis, presenting a nuanced assessment of this complex care transition. 8 Variability in transfer practices means ambiguity and subjectivity in decision making between transferring physicians and receiving physicians.…”

Demographics and Outcomes of Interhospital Transfer Patients Undergoing Intracranial Tumor Resection: A Retrospective Cohort Analysis

“…Several published studies support an association between IHT and higher mortality [1,2,20,21]. Contrarily, in the present study, we found that IHT patients had fewer complications as measured by CDS.…”

Application of comprehensive unit-based safety program model in the inter-hospital transfer of patients with critical diseases: a retrospective controlled study

“…In a retrospective study of IHT in patients with acute myocardial infarction, Mueller et al [ 23 ] pointed out that medical transfer often occurred in the hospital, which made patients face the potential risk of nursing interruption. Thus, patients and medical staff experienced some pressure.…”