London Jason A, Rosengart Matthew R, Jurkovich Gregory J, Nathens Avery B
Division of Trauma/General Surgery, Harborview Medical Center, Department of Surgery, University of Washington, Seattle, Washington 98104, USA.
J Trauma. 2006 Feb;60(2):390-5; discussion 395-6. doi: 10.1097/01.ta.0000203586.66214.34.
Transfer patients (TP) differ from patients transported directly from the field (DP) by virtue of their complexity and delays to definitive care, factors that might impact on costs and resource utilization and aggravate the adverse selection that already threatens TC reimbursement.
This is a retrospective cohort study where patients admitted to a Level I trauma center were classified as a TP or DP. Crude and adjusted total costs, complications, length of stay, and proportion of DRG outliers were compared across the two cohorts.
Among 8,665 patients, 40% were transferred. TP were more likely to be DRG outliers (15% versus 10%, p < 0.001). Costs in 65% of the DRGs were higher in the TP. Rates of complications and length of stay were significantly greater in the TP.
There are systematic differences in resource consumption between transferred patients and patients transported directly from the field. These differences render conventional DRG-based mechanisms of reimbursement inadequate, suggesting a need for recognition of the transfer patient as a distinct entity by payers.
转运患者（TP）因其病情复杂以及确定性治疗延迟，与直接从现场转运来的患者（DP）不同，这些因素可能影响成本和资源利用，并加剧已经威胁到创伤中心报销的逆向选择。
这是一项回顾性队列研究，将入住一级创伤中心的患者分为转运患者或直接转运患者。比较了两组患者的原始和调整后的总成本、并发症、住院时间以及诊断相关分组（DRG）异常值的比例。
在8665例患者中，40%为转运患者。转运患者更有可能是DRG异常值（15%对10%，p<0.001）。65%的DRG中，转运患者的成本更高。转运患者的并发症发生率和住院时间显著更长。
转运患者与直接从现场转运来的患者在资源消耗方面存在系统性差异。这些差异使得基于传统DRG的报销机制不足，表明支付方需要将转运患者视为一个独特的实体。
