Against the current: back-transfer as a mechanism for rural regionalization

Leah F Nelson; Karisa K Harland; Dan M Shane; Azeemuddin Ahmed; Nicholas M Mohr

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Journal article

Against the current: back-transfer as a mechanism for rural regionalization

Leah F Nelson, Karisa K Harland, Dan M Shane, Azeemuddin Ahmed and Nicholas M Mohr

The American journal of managed care, Vol.23(9), pp.e287-e294

09/01/2017

PMID: 29087168

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Abstract

This paper investigates back-transfer: the transfer of patients near the end of their acute hospitalization to a local community hospital for the completion of their medical care. We seek to describe factors contributing to back-transfer, with the goal of elucidating the current use of back-transfer and barriers to its more widespread adoption for rural healthcare regionalization. Observational unmatched case-control. This was a retrospective study of adults hospitalized in Iowa between 2005 and 2013 to identify back-transferred patients. Demographic, geographic, rurality, procedural, and disease information was compared among cases and control groups using univariate analysis and multivariable logistic regression. Over the 9-year period, 172,544 back-transfer eligible patients were admitted to 1 of 5 large Iowa hospitals, of which 287 (0.2%) were back-transferred. Back-transferred patients were more likely than their non-back-transferred counterparts to be older, male, and white; to live in large rural areas; and to have public insurance. As inpatients, they had longer median lengths of stay (15 vs 5 days; P <.001), more medical comorbidities, and were more likely to have a cardiac catheterization procedure than the control group. Back-transfer is a very rare event. While demographic and medical differences between back-transferred patients and controls may partially explain the infrequency, other systematic barriers must exist to limit back-transfer. These barriers likely include legal, financial, logistical, and patient care concerns. Despite the rarity with which it is employed, back-transfer is a promising strategy that could better utilize health resources, especially in rural America.

Regional Medical Programs - organization & administration

Humans

Middle Aged

Male

Case-Control Studies

Patient Transfer - organization & administration

Rural Health Services - organization & administration

Young Adult

Iowa

Adolescent

Aged, 80 and over

Adult

Female

Aged

Retrospective Studies

Details

Title: Subtitle: Against the current: back-transfer as a mechanism for rural regionalization
Creators: Leah F Nelson
Karisa K Harland
Dan M Shane
Azeemuddin Ahmed
Nicholas M Mohr - University of Iowa Carver College of Medicine, 200 Hawkins Dr, 1008 RCP, Iowa City, IA 52242. E-mail: Nicholas-mohr@uiowa.edu
Resource Type: Journal article
Publication Details: The American journal of managed care, Vol.23(9), pp.e287-e294
PMID: 29087168
NLM abbreviation: Am J Manag Care
ISSN: 1088-0224
eISSN: 1936-2692
Publisher: United States
Language: English
Date published: 09/01/2017
Academic Unit: Health Management and Policy; Management and Entrepreneurship ; Epidemiology; Economics; Emergency Medicine; Center for Social Science Innovation; Anesthesia; Injury Prevention Research Center; Public Policy Center (Archive); Law Faculty
Record Identifier: 9984025398002771

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