Interhospital Transfers Among Medicare Beneficiaries Admitted for Acute Myocardial Infarction at Nonrevascularization Hospitals

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dc.contributor.author Iwashyna, Theodore
dc.contributor.author Kahn, Jeremy
dc.contributor.author Hayward, Rodney
dc.contributor.author Nallamothu, Brahmajee
dc.date.accessioned 2010-09-16T20:12:46Z
dc.date.available 2010-09-16T20:12:46Z
dc.date.issued 2010-09
dc.identifier.citation Iwashyna TJ, Kahn JM, Hayward RA, Nallamothu BK. Interhospital transfers among Medicare beneficiaries admitted for acute myocardial infarction at non-revascularization hospitals. Circ: Cardiovasc Qual Outcomes 2010; 3(5):468-475 <http://hdl.handle.net/2027.42/78005> en_US
dc.identifier.uri http://hdl.handle.net/2027.42/78005
dc.description.abstract Background—Patients with acute myocardial infarction (AMI) who are admitted to hospitals without coronary revascularization are frequently transferred to hospitals with this capability, yet we know little about the basis for how such revascularization hospitals are selected. Methods and Results—We examined interhospital transfer patterns in 71 336 AMI patients admitted to hospitals without revascularization capabilities in the 2006 Medicare claims using network analysis and regression models. A total of 31 607 (44.3%) AMI patients were transferred from 1684 nonrevascularization hospitals to 1104 revascularization hospitals. Median time to transfer was 2 days. Median transfer distance was 26.7 miles, with 96.1% within 100 miles. In 45.8% of cases, patients bypassed a closer hospital to go to a farther hospital that had a better 30-day risk standardized mortality rates. However, in 36.8% of cases, another revascularization hospital with lower 30-day risk-standardized mortality was actually closer to the original admitting nonrevascularization hospital than the observed transfer destination. Adjusted regression models demonstrated that shorter transfer distances were more common than transfers to the hospitals with lowest 30-day mortality rates. Simulations suggest that an optimized system that prioritized the transfer of AMI patients to a nearby hospital with the lowest 30-day mortality rate might produce clinically meaningful reductions in mortality. Conclusions—More than 40% of AMI patients admitted to nonrevascularization hospitals are transferred to revascular- ization hospitals. Many patients are not directed to nearby hospitals with the lowest 30-day risk-standardized mortality, and this may represent an opportunity for improvement. (Circ Cardiovasc Qual Outcomes. 2010;3:468-475.) en_US
dc.description.sponsorship This work was supported by 1K08HL091249-01 from the NIH/ NHLBI and used the Measurement Core of the Michigan Diabetes Research and Training Center (NIH/NIDDK, P60DK-20572). This project was also funded in part under a grant from the Pennsylvania Department of Health, which specifically disclaims responsibility for any analyses, interpretations, or conclusions. The funders were not involved in study design, interpretation, or the decision to publish. en_US
dc.format.extent 532802 bytes
dc.format.mimetype application/pdf
dc.language.iso en_US en_US
dc.publisher American Heart Asociation en_US
dc.subject Networks en_US
dc.subject Heart Attacks en_US
dc.subject Medicare Claims en_US
dc.subject Transfers en_US
dc.title Interhospital Transfers Among Medicare Beneficiaries Admitted for Acute Myocardial Infarction at Nonrevascularization Hospitals en_US
dc.type Article en_US
dc.subject.hlbsecondlevel Internal Medicine and Specialities
dc.subject.hlbtoplevel Health Sciences
dc.description.peerreviewed Peer Reviewed en_US
dc.contributor.affiliationum Pulmonary and Critical Care Medicine, Division of en_US
dc.contributor.affiliationum Internal Medicine, Department of en_US
dc.contributor.affiliationother University of Pittsburgh en_US
dc.contributor.affiliationumcampus Ann Arbor en_US
dc.identifier.pmid 20682917 en_US
dc.description.bitstreamurl http://deepblue.lib.umich.edu/bitstream/2027.42/78005/1/10.I.Circ.Outcomes.pdf
dc.identifier.doi 10.1161/CIRCOUTCOMES.110.957993
dc.identifier.source Circulation: Cardiovascular Quality & Outcomes en_US
dc.owningcollname Pulmonary & Critical Care Medicine, Division of
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