Journal article
Interhospital transfer among US veterans admitted to community and veterans affairs hospitals for acute myocardial infarction and ischemic stroke before and during the COVID‐19 pandemic
Journal of hospital medicine, Vol.20(2), pp.155-166
02/2025
DOI: 10.1002/jhm.13515
PMCID: PMC11797533
PMID: 39367748
Appears in UI Libraries Support Open Access
Abstract
Abstract Background Veterans Health Administration (VHA) enrollees may use community hospitals for inpatient care and sometimes require transfer to larger community or VHA hospitals. Little is known about interhospital transfer patterns among veterans using community and VHA hospitals or how coronavirus disease 2019 (COVID‐19) case surges affected transfer. Methods Retrospective cohort study among veterans age 65+ admitted to community and VHA hospitals for acute myocardial infarction (AMI) or acute ischemic stroke (AIS) during 2018–2021. We examined associations between COVID‐19 case density in regional hospital referral networks and the likelihood of transfer. Results A total of 8373 (23.6%) veterans with AMI and 4630 (13.1%) with AIS were transferred in the prepandemic period. Transfer was especially common for rural veterans (36% with AMI, 20% with AIS). Most transfers (88%) were between community hospitals and 6% from community to VHA. Among AMI patients, transfer was less likely among patients age >90 (relative to age 65–69), those with non‐White race/ethnicity, and females. Transfer was more common among patients initially seen in rural hospitals (AMI, odds ratio [OR] = 2.73, 95% confidence interval [CI], 2.90–3.74; AIS, OR = 2.43; 95% CI, 2.24–2.65). During 2020–2021, transfer among AMI patients was less likely during COVID‐19 case density surges affecting the admitting hospital's referral network (OR = 0.86; 95% CI, 0.78–0.96 for highest compared with lowest quartile of COVID‐19 cases). Conclusion Interhospital transfer was common for veterans with AMI and AIS, especially among rural veterans. Few transfers were to VHA hospitals. COVID‐19 case surges were associated with decreased transfer for veterans with AMI, potentially limiting access to needed care.
Details
- Title: Subtitle
- Interhospital transfer among US veterans admitted to community and veterans affairs hospitals for acute myocardial infarction and ischemic stroke before and during the COVID‐19 pandemic
- Creators
- Mary S. Vaughan-Sarrazin - University of IowaKelly Richardson Miell - Iowa City VA Health Care SystemBrice F. Beck - Iowa City VA Health Care SystemBradley Mecham - Iowa City VA Health Care SystemGeorge Bailey - Iowa City VA Health Care SystemShylo Wardyn - Iowa City VA Health Care SystemNicholas Mohr - University of IowaMichael Ohl - University of Iowa
- Resource Type
- Journal article
- Publication Details
- Journal of hospital medicine, Vol.20(2), pp.155-166
- DOI
- 10.1002/jhm.13515
- PMID
- 39367748
- PMCID
- PMC11797533
- NLM abbreviation
- J Hosp Med
- ISSN
- 1553-5592
- eISSN
- 1553-5606
- Publisher
- Wiley
- Grant note
Department of VA, Veterans Health Administration Office of Rural Health; VA Health Services Research and Development service
- Language
- English
- Electronic publication date
- 10/05/2024
- Date published
- 02/2025
- Academic Unit
- Psychiatry; Health Management and Policy; Epidemiology; Emergency Medicine; Anesthesia; Injury Prevention Research Center; General Internal Medicine; Otolaryngology; Internal Medicine
- Record Identifier
- 9984722714802771
Metrics
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