Rafaqat Wardah, Mahmud Omar, Alba Christopher, Abiad May, Lagazzi Emanuele, Argandykov Dias, Hwabejire John O, Velmahos George C, Parks Jonathan J, DeWane Michael P
Medical College, Aga Khan University, Karachi, Sindh, Pakistan.
Harvard Medical School, Boston, MA, USA.
Health Serv Insights. 2025 Jul 23;18:11786329251357378. doi: 10.1177/11786329251357378. eCollection 2025.
Affiliations between community and academic hospitals are increasing. However, their impact on transfer practices remains under-characterized.
To understand the impacts of hospital affiliation on transfer practices and hospital resource utilization.
Retrospective cohort study.
We included patients ⩾18 years who were transferred from a 178-bed community hospital to a tertiary academic hospital between January 2015 to December 2019. Interrupted time series analysis was used to evaluate changes in outcomes after the affiliation in January 2017. Our primary outcome was the change in quarterly rate of early discharge (discharge within 48 hours post-transfer). Secondary outcomes included change in quarterly proportions of low-income patients, patients residing at a far distance from the hospital, and ICU admissions. We performed a sub-analysis in patients transferred to a surgical specialty that evaluated the tri-annual rate of operative management (surgical or interventional radiology procedure performed <72 hours after admission).
Among 144 included patients, 93 (64.6%) were transferred post-affiliation and 63 (43.1%) were transferred to a surgical specialty. No significant trends were seen across outcomes in the pre-affiliation period. Relative to the former period, there was a quarterly decrease in early discharge rates ( = .027) and a quarterly increase in the percentage of patients residing at a long distance from the transferring hospital ( = .027) after affiliation. There was also a relative tri-annual decrease in the rate of operative management ( = .039).
Post-affiliation, the volume of transfers and utilization of resources at the receiving hospital increased. The percentage of transfer patients residing farther from the transferring hospital also increased.
社区医院与学术医院之间的合作日益增多。然而，它们对转诊实践的影响仍未得到充分描述。
了解医院合作对转诊实践和医院资源利用的影响。
回顾性队列研究。
我们纳入了2015年1月至2019年12月期间从一家拥有178张床位的社区医院转诊至三级学术医院的18岁及以上患者。采用中断时间序列分析来评估2017年1月合作后结局的变化。我们的主要结局是早期出院季度率（转诊后48小时内出院）的变化。次要结局包括低收入患者、居住在离医院较远地区的患者以及入住重症监护病房患者的季度比例变化。我们对转诊至外科专科的患者进行了亚分析，评估了手术治疗的三年率（入院后<72小时进行的手术或介入放射学程序）。
在纳入的144例患者中，93例（64.6%）在合作后转诊，63例（43.1%）转诊至外科专科。在合作前的时期内，各结局均未观察到显著趋势。与前期相比，合作后早期出院率季度下降（P = 0.027），居住在离转诊医院较远地区的患者百分比季度增加（P = 0.027）。手术治疗率也相对三年下降（P = 0.039）。
合作后，接收医院的转诊量和资源利用率增加。居住在离转诊医院更远地区的转诊患者百分比也增加了。
