Methods for Handling Inter-Hospital Transfer in acute Myocardial Infarction Research

Abstract

Context:Patients are frequently transferred during their care for acute myocardial infarction. The clinical risks and benefi ts associated with inter-hospital transfer have not been fully evaluated.Objective: To compare and contrast the analytic methods used to handle transferred patients in previous acute myocardial infarction research.Design: Systematic review of acute myocardial infarction literature over the past 10 years.Main Outcomes: Benefi ts and risks of various methods used for handling transferred patients in acute myocardial infarction research.Results: Seven major methods for dealing with inter-hospital transfer emerged: 1) Count each hospitalization as a separate event. 2) Delete transferred patients from analysis. 3) Link the data from different hospitals and produce a record of the "episode" of acute myocardial infarction. 4) Analyze data on transferred patients the same as on non-transferred patients. 5) Transfer patients are the specifi c population of interest. 6) Diagnosis, treatment, outcomes are attributed to the index hospital. 7) Control for transfer in logistic regression modeling. Several studies included a combination of these methods. Conclusion:Inter-hospital transfer in the care of acute MI is common and increasing. From a clinical standpoint, determining the patient most likely to benefi t from inter-hospital transfer will help guide clinicians faced with this diffi cult decision. From a health services standpoint it is essential to understand the implications of using a particular method for handling transfer patients, the impact on data collection, the data lost, the appropriate analyses, and the generalizability of fi ndings.

Transfer as Treatment in Rural Hospitals

“…2 Without careful attention to how interhospital transfer is handled in health care services research, bias against rural hospitals may be introduced into the analysis and interpretation of results. 3 If a patient presents to a rural hospital, the emergency department triage results in discharge, admission, or immediate transfer. Immediate transfer to another hospital is often not included in hospital discharge data (eg, the Healthcare Cost and Utilization Project and State Inpatient Databases).…”

“…Transfer out of a rural hospital is a common treatment decision . Without careful attention to how interhospital transfer is handled in health care services research, bias against rural hospitals may be introduced into the analysis and interpretation of results …”