Journal article
Against the current: back-transfer as a mechanism for rural regionalization
The American journal of managed care, Vol.23(9), pp.e287-e294
09/01/2017
PMID: 29087168
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.
Details
- Title: Subtitle
- Against the current: back-transfer as a mechanism for rural regionalization
- Creators
- Leah F NelsonKarisa K HarlandDan M ShaneAzeemuddin AhmedNicholas 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; Anesthesia; Injury Prevention Research Center; Public Policy Center (Archive); Law Faculty
- Record Identifier
- 9984025398002771
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