Interhospital Transfers to MUSC

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Presentation transcript:

Interhospital Transfers to MUSC Marc Heincelman, MD

Background- Source of Admission Emergency Dept Clinic MUSC Hospital Referring Hospital

Background- Interhospital Transfers Interhospital transfers (IHTs) account for approximately 3.5% of all hospital inpatient admissions (1.5 million per year) At MUSC, 15-20% of all admissions are IHTs IHT patients as a group are considered to be more complex with high resource utilization National Administrative Datasets (NIS and UHC) have demonstrated worse Steiner et al. The healthcare cost and utilization project: an overview. Effective clinical practice: ECP 2002;5:143-51. Mueller et al. Inter-hospital transfer and patient outcomes: a retrospective cohort study. BMJ quality & safety 2018. Nathens et al. The effect of interfacility transfer on outcome in an urban trauma system. The Journal of Trauma 2003;55:444-9.

Background- Interhospital Transfers National administrative datasets have demonstrated worse outcomes among interhospital transfers (IHT) compared to patients admitted directly from the ED Increased risk-adjusted mortality Increased adverse events Increased length of stay (LOS) Increased cost Decreased number of discharges to home National Administrative Datasets (NIS and UHC) have demonstrated worse Interhospital Transfer Patients Discharged by Academic Hospitalists. Sokol-Hessner et al. Journ Hosp Med. 2016.

Background- Interhospital Transfers Limitations of national administrative datasets Unable to adjust for patient-level characteristics Vitals Labs Individual diagnoses and comorbidities

Study Question At MUSC, is IHT status independently associated with inpatient mortality after adjusting for more detailed patient-level clinical characteristics?

Hypothesis IHT status will remain independently associated with inpatient mortality after adjusting for more detailed patient-level clinical characteristics?

Study Design Retrospective cohort study of adults admitted to MUSC internal medicine services from 2013-2014 Primary outcome= in-hospital mortality Independent variable of interest= IHT status Covariates: admit service, patient demographics, disease-specific conditions, labs, vitals Analysis= Cox proportional hazard regression analysis Cox regression analysis

Study Design 4 Cox proportional hazard regression analyses will be performed to examine the independent association between IHT status and in-hospital mortality, controlling for covariates that may be potential confounders to the relationship between transfer and death. Model 1- IHT status and admit service Model 2- Model 1 + patient demographics Model 3- Model 2 + comorbidities Model 4- Model 3 + clinical variables

Study Population Retrospective cohort study of 9328 adults admitted to MUSC internal medicine services from July 1, 2013 to June 30, 2014 Inclusion Criteria: All adults ≥18 years of age admitted to the following internal medicine services between July 1st, 2013 to June 30th, 2014 will be included: general internal medicine or internal medicine subspecialty services (medical intensive care unit (ICU), cardiology, gastroenterology, hepatology, or hematology/oncology services) if their records contain complete clinical data. Exclusion Criteria: Patients will be excluded if their records do not contain complete clinical data necessary for analysis. Cox regression analysis

Study Population Retrospective cohort study of 9328 adults admitted to MUSC internal medicine services from July 1, 2013 to June 30, 2014 Target Population: Adult patients with admission source of interhospital transfer Comparison Population: Adult patients with admission source of emergency department or clinic Cox regression analysis

Retrospective Cohort IHT In-hospital Mortality No in-hospital ED/Clinic No in-hospital Mortality

References Steiner C, Elixhauser A, Schnaier J. The healthcare cost and utilization project: an overview. Effective clinical practice : ECP 2002;5:143-51. Mueller S, Zheng J, Orav EJP, Schnipper JL. Inter-hospital transfer and patient outcomes: a retrospective cohort study. BMJ quality & safety 2018. Nathens AB, Maier RV, Brundage SI, Jurkovich GJ, Grossman DC. The effect of interfacility transfer on outcome in an urban trauma system. The Journal of trauma 2003;55:444-9. Sokol-Hessner L, White AA, Davis KF, Herzig SJ, Hohmann SF. Interhospital transfer patients discharged by academic hospitalists and general internists: Characteristics and outcomes. Journal of hospital medicine 2016;11:245-50. Hernandez-Boussard T, Davies S, McDonald K, Wang NE. Interhospital Facility Transfers in the United States: A Nationwide Outcomes Study. Journal of patient safety 2017;13:187-91.

Questions?