In:
Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 50, No. Suppl_1 ( 2019-02)
Abstract:
Background: The role of hospital factors in the decision to transfer acute ischemic stroke (AIS) patients is not clear. Objective: To determine whether hospital quality is associated with the transfer of stroke patients between 2 hospitals. Methods: Medicare claims data were used to identify AIS patients transferred between hospitals in the Northeast US from 2007-2011. We categorized hospitals as transferring hospitals (TH), retaining hospitals (RH), and accepting hospitals (AH) based on the largest proportion of AIS patient encounters that were transferred, retained, or accepted. All AHs participated in Get With The Guideline (GWTG)-Stroke, enabling the use of registry data to determine hospital performance by tPA use, composite quality measure score and door-to-needle (DTN) time for tPA. We identified connected TH-AH dyads as those with 〉 5 patients transferred annually and used logistic regression to identify hospital characteristics associated with the establishment of a given TH-AH connection. We fitted separate models for each measure of performance (rate of tPA use, GWTG composite quality measure and median DTN time); we also adjusted for driving distance between hospitals, AH stroke volume, and the number of hospitals in the AH’s referral region. Results: Of 394 Northeast hospitals, there were 136 THs, 241 RHs, and 17 AHs. The odds of an establishing an AH-TH connected dyad were influenced by many factors and increased when quality measure performance increased at the AH or decreased at the TH (Table). Conclusion: Among Northeast U.S. hospitals, we found that interfacility transfer destinations of choice were sensitive to differences in AH quality, with higher AH performance associated with increased likelihood of being a transfer destination. Further research is needed to better understand AIS transfer patterns in order to optimize the transfer system for maximal patient benefit in the future.
Type of Medium:
Online Resource
ISSN:
0039-2499
,
1524-4628
DOI:
10.1161/str.50.suppl_1.TMP70
Language:
English
Publisher:
Ovid Technologies (Wolters Kluwer Health)
Publication Date:
2019
detail.hit.zdb_id:
1467823-8
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