Rates, predictors, and variability of interhospital transfers

A national evaluation


Clinical question: What is the national frequency of interhospital transfers, and are there any patient or hospital factors that predict these transfers?

Background: Interhospital patient transfers may be due to the need for a specialized service, but the factors and patterns have not been well studied.

Study design: Cross-sectional analysis.

Setting: All acute care hospitals in the United States.

Synopsis: Using data from the 2013 Centers for Medicare & Medicaid Services and the 2013 American Hospital Association, this study showed that 1.5% of the 6.6 million eligible beneficiaries underwent interhospital transfer (IHT). Patient and hospital characteristics that increased the odds of IHT included age 74-85 years, nonblack race, higher comorbidity, lower diagnosis-related group weight, fewer recent hospitalizations, and hospitalization in the Northeast region of the United States. Lower case mix index was associated with increased odds of IHT. Rates of IHT remain variable, after adjusting for patient and hospital characteristics. This study was restricted to the Medicare population so did not represent all populations. IHT from the emergency room was not assessed, and those who were transferred more than once (to another hospital and back) were not included.

Bottom line: A large number of Medicare patients undergo IHT nationally, and the rate varies widely based on patient factors, geography, and other factors unrelated to patient or hospital characteristics.

Citation: Mueller SK, Jie Zheng, Orav EJ, Schnipper JL. Rates, predictors, and variability of interhospital transfers: A national evaluation. J Hosp Med. 2017;6:435-42.

Dr. Xu is assistant professor and hospitalist, Icahn School of Medicine of the Mount Sinai Health System, New York.

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