Journal article
Discordance Between Patient and Clinician Experiences and Priorities in Rural Interhospital Transfer: A Mixed Methods Study
The Journal of rural health, Vol.32(1), pp.25-34
2016
DOI: 10.1111/jrh.12125
PMID: 26174410
Abstract
Rural emergency department (ED) patients require interhospital transfer for definitive care at nearly 6 times the national rate, yet transfer decision-making is variable. The goal of this study was to understand patient experiences, preferences, and decision-making in the rural interhospital transfer process, and to measure the concordance between patient opinions and provider perceptions.
Ours is a mixed methods study of patients transferred to a 711-bed Midwestern academic medical center and the emergency physicians in community hospitals. Qualitative interviews were conducted by a single research assistant with admitted patients transferred from an ED, and a corresponding survey was distributed to community emergency physicians. Standardized scenarios were posed to both groups to understand transfer priorities.
Seventy-nine patients and 40 physicians participated in this study. Patients and physicians cited proximity to home, medical expertise, a personal relationship with a health care provider, health insurance, privacy concerns, and patient choice as the primary factors that influenced patient transfer priorities. Compared with patient respondents, physicians overestimated the patient-perceived importance of proximity to home (P = .015) and being cared for by a personal physician (P = .049), but they underestimated the value of receiving treatment in a comprehensive medical center (P = .002). In standardized scenarios, physicians agreed with patients in transfer preferences for conditions requiring neurosurgical consultation, but they underestimated patients' desire for transfer for pneumonia requiring mechanical ventilation.
Patients and physicians recognize similar factors that influence patient preferences in interhospital ED transfer, but physicians may overestimate the value of nonmedical influences on decision-making priorities.
Details
- Title: Subtitle
- Discordance Between Patient and Clinician Experiences and Priorities in Rural Interhospital Transfer: A Mixed Methods Study
- Creators
- Nicholas M Mohr - Division of Critical Care, Department of Anesthesia, University of Iowa Carver College of Medicine, Iowa City, IowaTerrence S Wong - Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, IowaBrett Faine - Department of Pharmaceutical Care, University of Iowa Hospitals and Clinics, Iowa City, IowaAdam Schlichting - Division of Pulmonary, Critical Care, and Occupational Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IowaJoseph Noack - Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, IowaAzeemuddin Ahmed - Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
- Resource Type
- Journal article
- Publication Details
- The Journal of rural health, Vol.32(1), pp.25-34
- DOI
- 10.1111/jrh.12125
- PMID
- 26174410
- NLM abbreviation
- J Rural Health
- ISSN
- 0890-765X
- eISSN
- 1748-0361
- Publisher
- England
- Grant note
- name: University of Iowa Department of Emergency Medicine; name: Emergency Medicine Foundation
- Language
- English
- Date published
- 2016
- Academic Unit
- Management and Entrepreneurship ; Epidemiology; Emergency Medicine; Pharmacy Practice and Science; Anesthesia; Injury Prevention Research Center
- Record Identifier
- 9984025295102771
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