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Identifying Racial/Ethnic Disparities in Interhospital Transfer: an Observational Study.
J Gen Intern Med. 2020 10; 35(10):2939-2946.JG

Abstract

BACKGROUND

Interhospital transfer (IHT) is often performed to provide patients with specialized care. Racial/ethnic disparities in IHT have been suggested but are not well-characterized.

OBJECTIVE

To evaluate the association between race/ethnicity and IHT.

DESIGN

Cross-sectional analysis of 2016 National Inpatient Sample data.

PATIENTS

Patients aged ≥ 18 years old with common medical diagnoses at transfer, including acute myocardial infarction, congestive heart failure, arrhythmia, stroke, sepsis, pneumonia, and gastrointestinal bleed.

MAIN MEASURES

We performed a series of logistic regression models to estimate adjusted odds of transfer by race/ethnicity controlling for patient demographics, clinical variables, and hospital characteristics and to identify potential mediators. In secondary analyses, we estimated adjusted odds of transfer among patients at community hospitals (those more likely to transfer patients) and performed subgroup analyses by region and primary medical diagnosis.

KEY RESULTS

Of 5,774,175 weighted hospital admissions, 199,015 (4.5%) underwent IHT, including 4.7% of White patients, compared with 3.9% of Black patients and 3.8% of Hispanic patients. Black (OR 0.83, 95% CI 0.78-0.89) and Hispanic (OR 0.81, 95% CI 0.75-0.87) patients had lower crude odds of transfer compared with White patients, but this became non-significant after adjusting for hospital-level characteristics. In secondary analyses among patients hospitalized at community hospitals, Hispanic patients had lower adjusted odds of transfer (aOR 0.89, 95% CI 0.79-0.98). Disparities in IHT by race/ethnicity varied by region and medical diagnosis.

CONCLUSIONS

Black and Hispanic patients had lower odds of IHT, largely explained by a higher likelihood of being hospitalized at urban teaching hospitals. Racial/ethnic disparities in transfer were demonstrated at community hospitals, in certain geographic regions and among patients with specific diseases.

Authors+Show Affiliations

Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA. eshannon2@bwh.harvard.edu. Harvard Medical School, Boston, MA, USA. eshannon2@bwh.harvard.edu.Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA. Harvard Medical School, Boston, MA, USA.Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA. Harvard Medical School, Boston, MA, USA.

Pub Type(s)

Journal Article
Observational Study
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

32700216

Citation

Shannon, Evan Michael, et al. "Identifying Racial/Ethnic Disparities in Interhospital Transfer: an Observational Study." Journal of General Internal Medicine, vol. 35, no. 10, 2020, pp. 2939-2946.
Shannon EM, Schnipper JL, Mueller SK. Identifying Racial/Ethnic Disparities in Interhospital Transfer: an Observational Study. J Gen Intern Med. 2020;35(10):2939-2946.
Shannon, E. M., Schnipper, J. L., & Mueller, S. K. (2020). Identifying Racial/Ethnic Disparities in Interhospital Transfer: an Observational Study. Journal of General Internal Medicine, 35(10), 2939-2946. https://doi.org/10.1007/s11606-020-06046-z
Shannon EM, Schnipper JL, Mueller SK. Identifying Racial/Ethnic Disparities in Interhospital Transfer: an Observational Study. J Gen Intern Med. 2020;35(10):2939-2946. PubMed PMID: 32700216.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Identifying Racial/Ethnic Disparities in Interhospital Transfer: an Observational Study. AU - Shannon,Evan Michael, AU - Schnipper,Jeffrey L, AU - Mueller,Stephanie K, Y1 - 2020/07/22/ PY - 2020/01/08/received PY - 2020/07/07/accepted PY - 2021/10/01/pmc-release PY - 2020/7/24/pubmed PY - 2021/5/15/medline PY - 2020/7/24/entrez KW - health disparities KW - health services research KW - hospital medicine KW - interhospital transfer SP - 2939 EP - 2946 JF - Journal of general internal medicine JO - J Gen Intern Med VL - 35 IS - 10 N2 - BACKGROUND: Interhospital transfer (IHT) is often performed to provide patients with specialized care. Racial/ethnic disparities in IHT have been suggested but are not well-characterized. OBJECTIVE: To evaluate the association between race/ethnicity and IHT. DESIGN: Cross-sectional analysis of 2016 National Inpatient Sample data. PATIENTS: Patients aged ≥ 18 years old with common medical diagnoses at transfer, including acute myocardial infarction, congestive heart failure, arrhythmia, stroke, sepsis, pneumonia, and gastrointestinal bleed. MAIN MEASURES: We performed a series of logistic regression models to estimate adjusted odds of transfer by race/ethnicity controlling for patient demographics, clinical variables, and hospital characteristics and to identify potential mediators. In secondary analyses, we estimated adjusted odds of transfer among patients at community hospitals (those more likely to transfer patients) and performed subgroup analyses by region and primary medical diagnosis. KEY RESULTS: Of 5,774,175 weighted hospital admissions, 199,015 (4.5%) underwent IHT, including 4.7% of White patients, compared with 3.9% of Black patients and 3.8% of Hispanic patients. Black (OR 0.83, 95% CI 0.78-0.89) and Hispanic (OR 0.81, 95% CI 0.75-0.87) patients had lower crude odds of transfer compared with White patients, but this became non-significant after adjusting for hospital-level characteristics. In secondary analyses among patients hospitalized at community hospitals, Hispanic patients had lower adjusted odds of transfer (aOR 0.89, 95% CI 0.79-0.98). Disparities in IHT by race/ethnicity varied by region and medical diagnosis. CONCLUSIONS: Black and Hispanic patients had lower odds of IHT, largely explained by a higher likelihood of being hospitalized at urban teaching hospitals. Racial/ethnic disparities in transfer were demonstrated at community hospitals, in certain geographic regions and among patients with specific diseases. SN - 1525-1497 UR - https://www.unboundmedicine.com/medline/citation/32700216/Identifying_Racial/Ethnic_Disparities_in_Interhospital_Transfer:_an_Observational_Study_ L2 - https://dx.doi.org/10.1007/s11606-020-06046-z DB - PRIME DP - Unbound Medicine ER -