Department of Emergency Medicine, Massachusetts General Hospital.
School of Arts and Sciences, Tufts University, Medford, MA.
Pediatr Emerg Care. 2024 Nov 1;40(11):806-811. doi: 10.1097/PEC.0000000000003263. Epub 2024 Aug 23.
Our objective was to identify the hospital- and community-related factors associated with the hospital-level rate of potentially unnecessary interfacility transfers (IFTs) for pediatric patients with asthma exacerbations.
We analyzed California Emergency Department (ED) data from 2016 to 2019 to capture ED visits where a pediatric patient (age, 2-17 years) presented with an asthma exacerbation and was transferred to another ED or acute care hospital. The primary outcome was hospital-level rate of potentially unnecessary IFTs, defined as a visit where length of stay after transfer was <24 hours and no advanced services (eg, critical care) were used. Hospital- and community-related characteristics included urbanicity, teaching hospital status, availability of pediatric resources in the sending facility and patient's community, pediatric patient volume, and Social Vulnerability Index. We described and compared hospitals in the top quartile of potentially unnecessary IFT rate versus all others and used a multivariable modified Poisson model to identify factors associated with potentially unnecessary IFT.
A total of 325 sending hospitals were included, with a median 573 pediatric asthma visits (interquartile range, 183-1309) per hospital annually. Nearly half of the hospitals (145/325, 45%) sent a potentially unnecessary IFT. Most (90%) hospitals were urban, 9% were teaching hospitals, 5% had >500 beds, and 22% had a pediatric ED on-site. Factors associated with higher adjusted prevalence of potentially unnecessary IFT included availability of pediatric telehealth (prevalence ratio [PR], 1.5; 95% confidence interval [CI], 1.2-2.0), increased pediatric volume (eg, <1800 vs ≥10,000 visits: PR, 2.6; 95% CI, 1.4-4.7), and higher community Social Vulnerability Index (PR, 1.5; 95% CI, 1.1-1.9).
Several hospital- and community-related factors were associated with potentially unnecessary IFTs among pediatric patients presenting to the ED with asthma exacerbations. These findings provide insight into disparities in potentially unnecessary IFT across communities and can guide the development of future interventions.
本研究旨在确定与儿科哮喘发作患者的院内和社区相关的因素，这些因素与潜在不必要的院内转院（IFT）的医院级别比率有关。
我们分析了 2016 年至 2019 年加利福尼亚州急诊部（ED）的数据，以捕获 ED 就诊记录，其中儿科患者（年龄 2-17 岁）出现哮喘加重，并转至另一家 ED 或急性护理医院。主要结局为潜在不必要 IFT 的医院级别比率，定义为转院后住院时间<24 小时且未使用高级服务（如重症监护）的就诊。医院和社区相关特征包括城市性、教学医院地位、转往医院和患者社区中儿科资源的可用性、儿科患者数量以及社会脆弱性指数。我们描述并比较了潜在不必要 IFT 率处于前四分之一的医院与其他所有医院，并使用多变量修正泊松模型来确定与潜在不必要 IFT 相关的因素。
共纳入 325 家转院医院，每家医院每年的中位数为 573 例儿科哮喘就诊（四分位间距 183-1309）。近一半的医院（145/325，45%）转院了潜在不必要的 IFT。大多数（90%）医院为城市医院，9%为教学医院，5%的医院床位超过 500 张，22%的医院设有儿科 ED。与潜在不必要 IFT 更高的调整后患病率相关的因素包括儿科远程医疗的可用性（优势比[PR]，1.5；95%置信区间[CI]，1.2-2.0）、儿科就诊量增加（例如，<1800 与≥10,000 就诊：PR，2.6；95% CI，1.4-4.7）和更高的社区社会脆弱性指数（PR，1.5；95% CI，1.1-1.9）。
一些医院和社区相关因素与儿科患者因哮喘加重而到 ED 就诊时的潜在不必要 IFT 有关。这些发现提供了有关社区间潜在不必要 IFT 差异的见解，并可以指导未来干预措施的制定。
