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Racial and Geographic Disparities in Interhospital ICU Transfers.
Crit Care Med. 2018 01; 46(1):e76-e80.CC

Abstract

OBJECTIVES

Interhospital transfer, a common intervention, may be subject to healthcare disparities. In mechanically ventilated patients with sepsis, we hypothesize that disparities not disease related would be found between patients who were and were not transferred.

DESIGN

Retrospective cohort study.

SETTING

Nationwide Inpatient Sample, 2006-2012.

PATIENTS

Patients over 18 years old with a primary diagnosis of sepsis who underwent mechanical ventilation.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

We obtained age, gender, length of stay, race, insurance coverage, do not resuscitate status, and Elixhauser comorbidities. The outcome used was interhospital transfer from a small- or medium-sized hospital to a larger acute care hospital. Of 55,208,382 hospitalizations, 46,406 patients met inclusion criteria. In the multivariate model, patients were less likely to be transferred if the following were present: older age (odds ratio, 0.98; 95% CI, 0.978-0.982), black race (odds ratio, 0.79; 95% CI, 0.70-0.89), Hispanic race (odds ratio, 0.79; 95% CI, 0.69-0.90), South region hospital (odds ratio, 0.79; 95% CI, 0.72-0.88), teaching hospital (odds ratio, 0.31; 95% CI, 0.28-0.33), and do not resuscitate status (odds ratio, 0.19; 95% CI, 0.15-0.25).

CONCLUSIONS

In mechanically ventilated patients with sepsis, we found significant disparities in race and geographic location not explained by medical diagnoses or illness severity.

Authors+Show Affiliations

Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA.Departments of Anesthesiology and Neurosurgery, University of Virginia School of Medicine, Charlottesville, VA.Department of Medicine, Massachusetts General Hospital/Harvard Medical School, Boston, MA.Institute for History, Ethics and Philosophy of Medicine, Hannover Medical School, Hannover, Germany.Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA. Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA.Department of Medicine, University of British Columbia, Vancouver, BC, Canada.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

29068859

Citation

Tyler, Patrick D., et al. "Racial and Geographic Disparities in Interhospital ICU Transfers." Critical Care Medicine, vol. 46, no. 1, 2018, pp. e76-e80.
Tyler PD, Stone DJ, Geisler BP, et al. Racial and Geographic Disparities in Interhospital ICU Transfers. Crit Care Med. 2018;46(1):e76-e80.
Tyler, P. D., Stone, D. J., Geisler, B. P., McLennan, S., Celi, L. A., & Rush, B. (2018). Racial and Geographic Disparities in Interhospital ICU Transfers. Critical Care Medicine, 46(1), e76-e80. https://doi.org/10.1097/CCM.0000000000002776
Tyler PD, et al. Racial and Geographic Disparities in Interhospital ICU Transfers. Crit Care Med. 2018;46(1):e76-e80. PubMed PMID: 29068859.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Racial and Geographic Disparities in Interhospital ICU Transfers. AU - Tyler,Patrick D, AU - Stone,David J, AU - Geisler,Benjamin P, AU - McLennan,Stuart, AU - Celi,Leo Anthony, AU - Rush,Barret, PY - 2017/10/27/pubmed PY - 2017/12/28/medline PY - 2017/10/26/entrez SP - e76 EP - e80 JF - Critical care medicine JO - Crit Care Med VL - 46 IS - 1 N2 - OBJECTIVES: Interhospital transfer, a common intervention, may be subject to healthcare disparities. In mechanically ventilated patients with sepsis, we hypothesize that disparities not disease related would be found between patients who were and were not transferred. DESIGN: Retrospective cohort study. SETTING: Nationwide Inpatient Sample, 2006-2012. PATIENTS: Patients over 18 years old with a primary diagnosis of sepsis who underwent mechanical ventilation. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We obtained age, gender, length of stay, race, insurance coverage, do not resuscitate status, and Elixhauser comorbidities. The outcome used was interhospital transfer from a small- or medium-sized hospital to a larger acute care hospital. Of 55,208,382 hospitalizations, 46,406 patients met inclusion criteria. In the multivariate model, patients were less likely to be transferred if the following were present: older age (odds ratio, 0.98; 95% CI, 0.978-0.982), black race (odds ratio, 0.79; 95% CI, 0.70-0.89), Hispanic race (odds ratio, 0.79; 95% CI, 0.69-0.90), South region hospital (odds ratio, 0.79; 95% CI, 0.72-0.88), teaching hospital (odds ratio, 0.31; 95% CI, 0.28-0.33), and do not resuscitate status (odds ratio, 0.19; 95% CI, 0.15-0.25). CONCLUSIONS: In mechanically ventilated patients with sepsis, we found significant disparities in race and geographic location not explained by medical diagnoses or illness severity. SN - 1530-0293 UR - https://www.unboundmedicine.com/medline/citation/29068859/Racial_and_Geographic_Disparities_in_Interhospital_ICU_Transfers_ L2 - https://dx.doi.org/10.1097/CCM.0000000000002776 DB - PRIME DP - Unbound Medicine ER -