Insurance Coverage Predicts Mortality in Patients Transferred Between Hospitals: a Cross-Sectional Study

Usher, Michael; Fanning, Christine; Fang, Vivian W.; Carroll, Madeline; Parikh, Amay; Joseph, Anne M.; Herrigel, Dana

doi:10.1007/s11606-018-4687-0

Cited by 11 publications

(9 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, risks of interhospital transfers include higher rates of delayed care, miscommunication, error, and mortality 36–38 . In addition, it has been suggested that interhospital transfers may exacerbate some racial and economic health disparities 39,40 …”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Responding to COVID-19 Through Interhospital Resource Coordination: A Mixed-Methods Evaluation

et al. 2021

Self Cite

View full text Add to dashboard Cite

ObjectivesThe COVID-19 pandemic stressed hospital operations, requiring rapid innovations to address rise in demand and specialized COVID-19 services while maintaining access to hospital-based care and facilitating expertise. We aimed to describe a novel hospital system approach to managing the COVID-19 pandemic, including multihospital coordination capability and transfer of COVID-19 patients to a single, dedicated hospital.MethodsWe included patients who tested positive for SARS-CoV-2 by polymerase chain reaction admitted to a 12-hospital network including a dedicated COVID-19 hospital. Our primary outcome was adherence to local guidelines, including admission risk stratification, anticoagulation, and dexamethasone treatment assessed by differences-in-differences analysis after guideline dissemination. We evaluated outcomes and health care worker satisfaction. Finally, we assessed barriers to safe transfer including transfer across different electronic health record systems.ResultsDuring the study, the system admitted a total of 1209 patients. Of these, 56.3% underwent transfer, supported by a physician-led System Operations Center. Patients who were transferred were older (P = 0.001) and had similar risk-adjusted mortality rates. Guideline adherence after dissemination was higher among patients who underwent transfer: admission risk stratification (P < 0.001), anticoagulation (P < 0.001), and dexamethasone administration (P = 0.003). Transfer across electronic health record systems was a perceived barrier to safety and reduced quality. Providers positively viewed our transfer approach.ConclusionsWith standardized communication, interhospital transfers can be a safe and effective method of cohorting COVID-19 patients, are well received by health care providers, and have the potential to improve care quality.

show abstract

Section: Discussionmentioning

confidence: 99%

“… 36 – 38 In addition, it has been suggested that interhospital transfers may exacerbate some racial and economic health disparities. 39 , 40 …”

Section: Discussionmentioning

confidence: 99%

Responding to COVID-19 Through Interhospital Resource Coordination: A Mixed-Methods Evaluation

et al. 2021

Self Cite

View full text Add to dashboard Cite

show abstract

“…[10][11][12][13][14][15][16][17] Whether racial and ethnic disparities in IHT contribute to gaps in healthcare access is less well studied. Prior IHT research, 1,3,[18][19][20][21][22][23][24][25][26][27][28][29] including registry-based studies exploring factors associated with IHT, 1,4,24 has suggested influence of non-clinical factors, including race/ethnicity, on transfer practices. The most robust body of evidence derives from the cardiology literature, 3,19,20,23,26 in which minority patients have been shown to be less likely to be transferred to hospitals with revascularization capabilities.…”

Section: Introductionmentioning

confidence: 99%

Identifying Racial/Ethnic Disparities in Interhospital Transfer: an Observational Study

2020

View full text Add to dashboard Cite

BACKGROUND: Interhospital transfer (IHT) is often performed to provide patients with specialized care. Racial/ ethnic disparities in IHT have been suggested but are not well-characterized. OBJECTIVE: To evaluate the association between race/ ethnicity and IHT. DESIGN: Cross-sectional analysis of 2016 National Inpatient Sample data. PATIENTS: Patients aged ≥ 18 years old with common medical diagnoses at transfer, including acute myocardial infarction, congestive heart failure, arrhythmia, stroke, sepsis, pneumonia, and gastrointestinal bleed. MAIN MEASURES: We performed a series of logistic regression models to estimate adjusted odds of transfer by race/ethnicity controlling for patient demographics, clinical variables, and hospital characteristics and to identify potential mediators. In secondary analyses, we estimated adjusted odds of transfer among patients at community hospitals (those more likely to transfer patients) and performed subgroup analyses by region and primary medical diagnosis. KEY RESULTS: Of 5,774,175 weighted hospital admissions, 199,015 (4.5%) underwent IHT, including 4.7% of White patients, compared with 3.9% of Black patients and 3.8% of Hispanic patients. Black (OR 0.83, 95% CI 0.78-0.89) and Hispanic (OR 0.81, 95% CI 0.75-0.87) patients had lower crude odds of transfer compared with White patients, but this became non-significant after adjusting for hospital-level characteristics. In secondary analyses among patients hospitalized at community hospitals, Hispanic patients had lower adjusted odds of transfer (aOR 0.89, 95% CI 0.79-0.98). Disparities in IHT by race/ ethnicity varied by region and medical diagnosis. CONCLUSIONS: Black and Hispanic patients had lower odds of IHT, largely explained by a higher likelihood of being hospitalized at urban teaching hospitals. Racial/ ethnic disparities in transfer were demonstrated at community hospitals, in certain geographic regions and among patients with specific diseases.

show abstract

“…There is little evidence to suggest that hospitals receive lower reimbursement rates for patients who are dualeligible for Medicare and Medicaid, 34 and in this study, we found Medicaid coinsurance to be associated with lower rates of transfer. However, results from other studies [35][36][37][38][39] have suggested that underinsured patients are more likely to be transferred. Third, inaccuracies in coding Hispanic patients may contribute to some of these observations, as further discussed in Limitations.…”

Section: Jama Network Open | Health Policymentioning

confidence: 94%

Racial/Ethnic Disparities in Interhospital Transfer for Conditions With a Mortality Benefit to Transfer Among Patients With Medicare

et al. 2021

View full text Add to dashboard Cite

show abstract

Insurance Coverage Predicts Mortality in Patients Transferred Between Hospitals: a Cross-Sectional Study

Cited by 11 publications

References 28 publications

Responding to COVID-19 Through Interhospital Resource Coordination: A Mixed-Methods Evaluation

Responding to COVID-19 Through Interhospital Resource Coordination: A Mixed-Methods Evaluation

Identifying Racial/Ethnic Disparities in Interhospital Transfer: an Observational Study

Racial/Ethnic Disparities in Interhospital Transfer for Conditions With a Mortality Benefit to Transfer Among Patients With Medicare

Contact Info

Product

Resources

About