Patterns of Hospital Bypass and Interhospital Transfer Among Patients With Heart Failure
Section snippets
Methods
This analysis aimed to (1) describe rural hospital bypass at the county level by excess travel time to admitting hospital, (2) identify factors associated with a higher likelihood of transfer of patients with HF, (3) establish the volume of HF admissions transferred between centers based on hospital characteristics, and (4) quantify the association between hospital transfer and mortality in patients with HF.
Results
Patient (N = 48,163) and hospital characteristics of the study population are described in Table 1. Evidence of rural hospital bypass was seen, as 42.5% and 55.9% of small town and rural residents, respectively, presented to metropolitan hospitals rather than hospitals of similar rurality (P < .001; Table 2). Rural patients demonstrated a mean excess travel time of 28.56 ± 45.60 minutes (median, 5.10 minutes; interquartile range, 42.53) (Figure 2). With each degree of increasing rurality as
Discussion
In this study, we quantify patterns of transfer based on hospital characteristics, identify patient factors associated with likelihood of transfer for HF care, and quantify the association between transfer and mortality. We demonstrate trends of rural hospital bypass and the heterogeneous distribution of excess travel time across rural communities. As expected, patients are most often transferred from rural to more urban hospitals. There are, however, significant disparities in the likelihood
Conclusions
This study provides several characterizations of rural hospital bypass and interhospital transfer for HF care. Hospital bypass occurs in rural communities. Patients are overwhelmingly transferred to metropolitan centers from all sending hospitals. Disparities in the likelihood of transfer exist among patients with HF on the basis of certain characteristics, including sex and age. Transferred patients with HF are at high risk of in-hospital mortality.
Clinical Perspectives
This study has immediate clinical implications for provider consciousness of the patterns and risks of interhospital transfer for HF care. Our identification of bias against transfer in female and aged patients as well as identification of the increased risk of mortality in transfer can help to inform physician consideration of transfer for the individual patient. Our description of rural hospital bypass also helps to inform current policy discussion regarding health care regionalization and
Translational Outlook
To advance systems of regionalized HF care, further characterization of transfer practices and outcomes is needed. Such study should pertain to specific indications for transfer, interventions provided at receiving hospitals, and patient outcome by transfer indication in order to identify those patients with HF most likely to benefit from transfer. The ability to identify patients with HF in need of advanced therapies early, perhaps even through remote monitoring devices in the outpatient
Disclosures
None.
References (45)
- et al.
The effectiveness of regionalization of perinatal care services - a systematic review
Public Health
(2014) - et al.
Effectiveness of regionalization of trauma care services: a systematic review
Public Health
(2017) - et al.
Achieving regionalization through rural interhospital transfer
Am J Emerg Med
(2015) - et al.
Reasons underlying interhospital transfers to an academic medical intensive care unit
J Crit Care
(2013) - et al.
Heart failure in women: a need for prospective data
J Am Coll Cardiol
(2009) "I need help" - a mnemonic to aid timely referral in advanced heart failure
J Heart Lung Transplant
(2017)- et al.
Standardized team-based care for cardiogenic shock
J Am Coll Cardiol
(2019) - et al.
Patterns of hospital performance in acute myocardial infarction and heart failure 30-day mortality and readmission
Circ Cardiovasc Qual Outcomes
(2009) - Nunez-Smith M, Bradley E, Herrin J, Santana C, Curry LA, Normand SL, et al. Quality of care in the US territories.Arch...
- Heidenrich P, Lewis W, LaBresh K, Schwamm L, Fonarow G.Hospital performance recognition with the Get With The...
Utility of socioeconomic status in predicting 30-day outcomes after heart failure hospitalization
Circ Heart Fail
Association of hospital performance based on 30-day risk-standardized mortality rate with long-term survival after heart failure hospitalization: an analysis of the Get With The Guidelines heart failure registry
JAMA Cardiol
Specialist intervention is associated with improved patient outcomes in patients with decompensated heart failure: evaluation of the impact of a multidisciplinary inpatient heart failure team
Open Heart
Regionalization of critical care medicine: Task Force Report of the American College of Critical Care Medicine
Crit Care Med
Regionalization of medical critical care: what can we learn from the trauma experience?
Crit Care Med
Discordance between patient and clinician experiences and priorities in rural interhospital transfer: a mixed methods study
J Rural Health
Short-term outcomes and mortality after inter hospital intensive care transportation: an observational prospective cohort study of 368 consecutive transports with a mobile intensive care unit
BMJ Open
Insurance coverage predicts mortality in patients transferred between hospitals: a cross-sectional study
J Gen Intern Med
Contemporary management of cardiogenic shock: a scientific statement from the American Heart Association
Circulation
Inter-hospital transfer and patient outcomes: a retrospective cohort study
BMJ Qual Saf
Interhospital transfer patients discharged by academic hospitalists and general internists: characteristics and outcomes
J Hosp Med
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Supported by a Patient Centered Outcomes Research Program Pilot Funds Award.