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Patient and Hospital Characteristics Associated with Interhospital Transfer for Adults with Ventilator-Dependent Respiratory Failure.
Ann Am Thorac Soc. 2017 May; 14(5):730-736.AA

Abstract

RATIONALE

Patients with ventilator-dependent respiratory failure have improved outcomes at centers with greater expertise; yet, most patients are not treated in such facilities. Efforts to align care for respiratory failure and hospital capability would necessarily require interhospital transfer.

OBJECTIVES

To characterize the prevalence and the patient and hospital factors associated with interhospital transfer of adults residing in Florida with ventilator-dependent respiratory failure.

METHODS

We performed a retrospective, observational study using Florida Healthcare Cost and Utilization Project data. We selected patients 18 years of age and older with International Classification of Diseases, Ninth Revision, codes of respiratory failure and mechanical ventilation during 2012 and 2013, and we identified cohorts of patients that did and did not undergo interhospital transfer. We obtained patient sociodemographic and clinical variables and categorized hospitals into subtypes on the basis of patient volume and services provided: large, medium (nonprofit or for-profit), and small.

RESULTS

Interhospital transfer was our primary outcome measure. Patient sociodemographics, clinical variables, and hospital types were used as covariates. We identified 2,580 patients with ventilator-dependent respiratory failure who underwent interhospital transfer. Overall, transfer was uncommon, with only 2.9% of patients being transferred. In a hierarchical model, age less than 65 years (odds ratio [OR], 2.09; 95% confidence interval [CI], 1.77-2.45) and tracheostomy (OR, 3.19; 95% CI, 2.80-3.65) were associated with higher odds of transfer, whereas having Medicaid was associated with lower odds of transfer than having commercial insurance (OR, 0.65; 95% CI, 0.56-0.75). Additionally, care in medium-sized for-profit hospitals was associated with lower odds of transfer (OR, 1.37 vs. 2.70) than care in medium nonprofit hospitals, despite similar hospital characteristics.

CONCLUSIONS

In Florida, interhospital transfer of patients with ventilator-dependent respiratory failure is uncommon and more likely among younger, commercially insured, medically resource-intensive patients. For-profit hospitals are less likely to transfer than nonprofit hospitals. In future studies, researchers should test for geographic variations and examine the clinical implications of selectivity in interhospital transfer of patients with ventilator-dependent respiratory failure.

Authors+Show Affiliations

1 Division of Pulmonary and Critical Care Medicine, Department of Medicine, and.1 Division of Pulmonary and Critical Care Medicine, Department of Medicine, and.2 Department of Healthcare Leadership and Management, Medical University of South Carolina, Charleston, South Carolina.2 Department of Healthcare Leadership and Management, Medical University of South Carolina, Charleston, South Carolina.1 Division of Pulmonary and Critical Care Medicine, Department of Medicine, and.1 Division of Pulmonary and Critical Care Medicine, Department of Medicine, and.

Pub Type(s)

Journal Article
Observational Study

Language

eng

PubMed ID

28199137

Citation

Nadig, Nandita R., et al. "Patient and Hospital Characteristics Associated With Interhospital Transfer for Adults With Ventilator-Dependent Respiratory Failure." Annals of the American Thoracic Society, vol. 14, no. 5, 2017, pp. 730-736.
Nadig NR, Goodwin AJ, Simpson AN, et al. Patient and Hospital Characteristics Associated with Interhospital Transfer for Adults with Ventilator-Dependent Respiratory Failure. Ann Am Thorac Soc. 2017;14(5):730-736.
Nadig, N. R., Goodwin, A. J., Simpson, A. N., Simpson, K. N., Richards, J., & Ford, D. W. (2017). Patient and Hospital Characteristics Associated with Interhospital Transfer for Adults with Ventilator-Dependent Respiratory Failure. Annals of the American Thoracic Society, 14(5), 730-736. https://doi.org/10.1513/AnnalsATS.201611-918OC
Nadig NR, et al. Patient and Hospital Characteristics Associated With Interhospital Transfer for Adults With Ventilator-Dependent Respiratory Failure. Ann Am Thorac Soc. 2017;14(5):730-736. PubMed PMID: 28199137.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Patient and Hospital Characteristics Associated with Interhospital Transfer for Adults with Ventilator-Dependent Respiratory Failure. AU - Nadig,Nandita R, AU - Goodwin,Andrew J, AU - Simpson,Annie N, AU - Simpson,Kit N, AU - Richards,Jeremy, AU - Ford,Dee W, PY - 2017/2/16/pubmed PY - 2018/3/9/medline PY - 2017/2/16/entrez KW - Healthcare Cost and Utilization Project KW - nonprofit status KW - profit status KW - state inpatient database SP - 730 EP - 736 JF - Annals of the American Thoracic Society JO - Ann Am Thorac Soc VL - 14 IS - 5 N2 - RATIONALE: Patients with ventilator-dependent respiratory failure have improved outcomes at centers with greater expertise; yet, most patients are not treated in such facilities. Efforts to align care for respiratory failure and hospital capability would necessarily require interhospital transfer. OBJECTIVES: To characterize the prevalence and the patient and hospital factors associated with interhospital transfer of adults residing in Florida with ventilator-dependent respiratory failure. METHODS: We performed a retrospective, observational study using Florida Healthcare Cost and Utilization Project data. We selected patients 18 years of age and older with International Classification of Diseases, Ninth Revision, codes of respiratory failure and mechanical ventilation during 2012 and 2013, and we identified cohorts of patients that did and did not undergo interhospital transfer. We obtained patient sociodemographic and clinical variables and categorized hospitals into subtypes on the basis of patient volume and services provided: large, medium (nonprofit or for-profit), and small. RESULTS: Interhospital transfer was our primary outcome measure. Patient sociodemographics, clinical variables, and hospital types were used as covariates. We identified 2,580 patients with ventilator-dependent respiratory failure who underwent interhospital transfer. Overall, transfer was uncommon, with only 2.9% of patients being transferred. In a hierarchical model, age less than 65 years (odds ratio [OR], 2.09; 95% confidence interval [CI], 1.77-2.45) and tracheostomy (OR, 3.19; 95% CI, 2.80-3.65) were associated with higher odds of transfer, whereas having Medicaid was associated with lower odds of transfer than having commercial insurance (OR, 0.65; 95% CI, 0.56-0.75). Additionally, care in medium-sized for-profit hospitals was associated with lower odds of transfer (OR, 1.37 vs. 2.70) than care in medium nonprofit hospitals, despite similar hospital characteristics. CONCLUSIONS: In Florida, interhospital transfer of patients with ventilator-dependent respiratory failure is uncommon and more likely among younger, commercially insured, medically resource-intensive patients. For-profit hospitals are less likely to transfer than nonprofit hospitals. In future studies, researchers should test for geographic variations and examine the clinical implications of selectivity in interhospital transfer of patients with ventilator-dependent respiratory failure. SN - 2325-6621 UR - https://www.unboundmedicine.com/medline/citation/28199137/Patient_and_Hospital_Characteristics_Associated_with_Interhospital_Transfer_for_Adults_with_Ventilator_Dependent_Respiratory_Failure_ L2 - https://www.atsjournals.org/doi/10.1513/AnnalsATS.201611-918OC?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -