Journal article
Safety of Back‐Transfer to Local Hospitals During an Acute Care Hospitalization
The Journal of rural health, Vol.34(4), pp.431-438
2018
DOI: 10.1111/jrh.12267
PMID: 28921673
Abstract
Purpose
This paper investigates patient outcomes including length of stay (LOS), cost of hospitalization, bounce‐back rates, transition to hospice care, and mortality, following back‐transfer.
Methods
This study was an observational case‐control study of adults hospitalized in Iowa between 2005 and 2013 to identify back‐transferred patients. Back‐transfer was defined as the transfer of rural patients near the end of their acute hospitalization in a comprehensive medical center back to a local community hospital for the completion of their medical care. Demographic, geographic, rurality, procedural, and disease information was compared between case and control groups, then propensity score (PS) matching was performed to create comparable groups to perform analyses.
Findings
Over the 9‐year period, 1,056,773 patients meeting inclusion criteria were admitted, of which 430 (0.04%) were back‐transferred. After PS matching, LOS was 60% (95% CI: 0.50‐0.71) higher and costs were 42% (95% CI: 0.33‐0.50) higher in the back‐transferred group. Back‐transferred cases had 8.34 (95% CI: 3.66‐19.0) times the odds of hospice transition and 2.17 (95% CI: 1.37‐3.46) the odds of mortality compared to controls. Four percent of back‐transfers “failed” with the patient being returned to the larger hospital before discharge.
Conclusions
Back‐transfer is a rare occurrence, and it is associated with longer LOS, higher hospitalization cost, higher mortality, more hospice transfers, and occasional bounce‐backs to comprehensive medical centers. Future work should focus more on prospective indications for transfer, the role of end‐of‐life care, financial impact, and identifying patient populations for whom back‐transfer is safest.
Details
- Title: Subtitle
- Safety of Back‐Transfer to Local Hospitals During an Acute Care Hospitalization
- Creators
- Leah F Nelson - University of New Mexico College of MedicineKarisa K Harland - University of Iowa Carver College of MedicineDan M Shane - University of Iowa College of Public HealthAzeemuddin Ahmed - University of Iowa Carver College of MedicineNicholas M Mohr - University of Iowa Carver College of Medicine
- Resource Type
- Journal article
- Publication Details
- The Journal of rural health, Vol.34(4), pp.431-438
- DOI
- 10.1111/jrh.12267
- PMID
- 28921673
- NLM abbreviation
- J Rural Health
- ISSN
- 0890-765X
- eISSN
- 1748-0361
- Number of pages
- 8
- Grant note
- Emergency Medicine Foundation
- Language
- English
- Date published
- 2018
- 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
- 9984025273902771
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