Patient and Hospital Characteristics Associated with Interhospital Transfer for Adults with Ventilator-Dependent Respiratory Failure

Abstract

Rationale: Patients with ventilator-dependent respiratory failure have improved outcomes at centers with greater expertise; yet, most patients are not treated in such facilities. Efforts to align care for respiratory failure and hospital capability would necessarily require interhospital transfer.Objectives: To characterize the prevalence and the patient and hospital factors associated with interhospital transfer of adults residing in Florida with ventilator-dependent respiratory failure.Methods: We performed a retrospective, observational study using Florida Healthcare Cost and Utilization Project data. We selected patients 18 years of age and older with International Classification of Diseases, Ninth Revision, codes of respiratory failure and mechanical ventilation during 2012 and 2013, and we identified cohorts of patients that did and did not undergo interhospital transfer. We obtained patient sociodemographic and clinical variables and categorized hospitals into subtypes on the basis of patient volume and services provided: large, medium (nonprofit or for-profit), and small.Results: Interhospital transfer was our primary outcome measure. Patient sociodemographics, clinical variables, and hospital types were used as covariates. We identified 2,580 patients with ventilatordependent respiratory failure who underwent interhospital transfer. Overall, transfer was uncommon, with only 2.9% of patients being transferred. In a hierarchical model, age less than 65 years (odds ratio [OR], 2.09; 95% confidence interval [CI], 1.77-2.45) and tracheostomy (OR, 3.19; 95% CI, 2.80-3.65) were associated with higher odds of transfer, whereas having Medicaid was associated with lower odds of transfer than having commercial insurance (OR, 0.65; 95% CI, 0.56-0.75). Additionally, care in medium-sized for-profit hospitals was associated with lower odds of transfer (OR, 1.37 vs. 2.70) than care in medium nonprofit hospitals, despite similar hospital characteristics. Conclusions:In Florida, interhospital transfer of patients with ventilator-dependent respiratory failure is uncommon and more likely among younger, commercially insured, medically resourceintensive patients. For-profit hospitals are less likely to transfer than nonprofit hospitals. In future studies, researchers should test for geographic variations and examine the clinical implications of selectivity in interhospital transfer of patients with ventilatordependent respiratory failure.

The Impact of Timing on Clinical and Economic Outcomes During Inter-ICU Transfer of Acute Respiratory Failure Patients: Time and Tide Wait for No One

“…Our prior work evaluating frequency of transfer of ARF patients in Florida showcased a modest transfer rate of 2.9% (10). As a follow-up, in this study, we did observe some variation in transfer frequencies at the state level with the highest rate of transfer observed in Maryland (4.7%).…”

“…All adult patients 18+ years old with an International Classification of Diseases , 9th and 10th Revision, Clinical Modification (ICD-9 and -10) diagnosis code corresponding to ARF (ICD-9-CM 518.81-.85, ICD-10-CM J96.00-.02), and procedure codes corresponding to mechanical ventilation (ICD-9-procedure code [PCS] 96.70-.72, ICD-10-PCS 5A1935Z, 5A1945Z, 5A1955Z) were identified. We excluded patients whose median LOS at hospital 1 was greater than 25 days as this is indicative of long-term acute care facilities (24, 25), as demonstrated in our prior study (10). In addition, we excluded patients in psychiatric hospitals to obtain our ARF cohort.…”

“…2, http://links.lww. com/CCX/A916) (10). Specifically, we constructed an indicator variable for invasive mechanical ventilation (IMV) at admission to hospital 1 denoted as (early IMV < 2 d).…”

“…Construction of Hospital Factors. Similarly, for hospital factors, we used our prior work, following the methods by Nadig et al (10). Hospitals were categorized as for profit or not-for-profit and small (< 100 beds), medium (100-300 beds), and large (> 300 beds).…”

Evaluation of factors associated with interhospital transfers to pediatric and adult tertiary level of care: A study of acute neurological disease cases

“…Predictive risk factors in addition to neurological deterioration are age and hydrocephalus, among others [ 15 ]. Studies on respiratory disease show lesser likelihood of transfers for patients over 65 years old [ 16 ]. Our study identified that trends in total referrals for migraine, neuro-ophthalmic disease and seizure disorders declined with advancing age but correlated with higher odds of potentially avoidable transfers across all age groups.…”