Mueller Stephanie K, Zheng Jie, Orav E John, Schnipper Jeffrey L
Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
J Hosp Med. 2017 Jun;12(6):435-442. doi: 10.12788/jhm.2747.
Interhospital transfer (IHT) remains a largely unstudied process of care.
To determine the nationwide frequency of, patient and hospital-level predictors of, and hospital variability in IHT.
Cross-sectional study.
Centers for Medicare and Medicaid 2013 100% Master Beneficiary Summary and Inpatient claims files merged with 2013 American Hospital Association data.
Beneficiaries ≥65 years and older enrolled in Medicare A and B, with an acute care hospitalization claim in 2013.
Patient and hospital characteristics of transferred and nontransferred patients.
Frequency of interhospital transfers (IHT); adjusted odds of transfer of each patient and each hospital characteristic; and variability in hospital transfer rates.
Of 6.6 million eligible beneficiaries with an acute care hospitalization, 101,507 (1.5%) underwent IHT. Selected characteristics associated with greater adjusted odds of transfer included: patient age 74-85 years (odds ratio [OR], 2.38 compared with 65-74 years; 95% confidence intervals [CI], 2.33-2.43); nonblack race (OR, 1.17; 95% CI, 1.13-1.20); higher comorbidity (OR, 1.37; 95% CI, 1.36-1.37); lower diagnosis-related group-weight (OR, 2.02; 95% CI, 1.95-2.09); fewer recent hospitalizations (OR, 1.87; 95% CI, 1.79-1.95); and hospitalization in the Northeast (OR, 1.40; 95% CI, 1.27-1.55). Higher case mix index of the hospital was associated with a lower adjusted odds of transfer (OR, 0.36; 95% CI, 0.30-0.45). Variability in hospital transfer rates remained significant after adjustment for patient and hospital characteristics (variance 0.28, P = 0.01).
In this nationally representative evaluation, we found that a sizable number of patients undergo IHT. We identified both expected and unexpected patient and hospital-level predictors of IHT, as well as unexplained variability in hospital transfer rates, suggesting lack of standardization of this complex care transition. Our study highlights further investigative avenues to help guide best practices in IHT. Journal of Hospital Medicine 2017;12:435-442.
医院间转运（IHT）在很大程度上仍是一个未被充分研究的医疗过程。
确定全国范围内IHT的发生频率、患者及医院层面的预测因素以及医院间的差异。
横断面研究。
将医疗保险和医疗补助服务中心2013年100%的主要受益人汇总数据与住院患者索赔文件，与2013年美国医院协会数据合并。
年龄≥65岁且参加了医疗保险A部分和B部分，并在2013年有急性护理住院索赔的受益人。
转运患者和未转运患者的患者及医院特征。
医院间转运（IHT）的频率；每位患者和每个医院特征的调整后转运几率；以及医院转运率的差异。
在660万符合条件的有急性护理住院治疗的受益人中，101,507人（1.5%）接受了IHT。与调整后较高转运几率相关的选定特征包括：患者年龄74 - 85岁（比值比[OR]，与65 - 74岁相比为2.38；95%置信区间[CI]，2.33 - 2.43）；非黑人种族（OR，1.17；95% CI，1.13 - 1.20）；较高的合并症（OR，1.37；95% CI，1.36 - 1.37）；较低的诊断相关组权重（OR，2.02；95% CI，1.95 - 2.09）；近期住院次数较少（OR，1.87；95% CI，1.79 - 1.95）；以及在东北部住院（OR，1.40；95% CI，1.27 - 1.55）。医院较高的病例组合指数与较低的调整后转运几率相关（OR，0.36；95% CI，0.30 - 0.45）。在对患者和医院特征进行调整后，医院转运率的差异仍然显著（方差0.28，P = 0.01）。
在这项具有全国代表性的评估中，我们发现有相当数量的患者接受IHT。我们确定了IHT在患者及医院层面的预期和意外预测因素，以及医院转运率中无法解释的差异，这表明这种复杂的医疗过渡缺乏标准化。我们的研究突出了进一步的调查途径，以帮助指导IHT的最佳实践。《医院医学杂志》2017年；12：435 - 442。
