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Interfacility Transfers Among Patients With Complex Chronic Conditions
Michelle J White1, Ashley G Sutton2, Victor Ritter3
1Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, School of Medicine, and michelle.white@duke.edu.
Insights
Interfacility transfer for children with complex chronic conditions (CCCs) is common and associated with worse outcomes. Transferred children experienced longer hospital stays, increased critical care, and higher mortality rates.
Area of Science:
- Pediatric Healthcare
- Health Services Research
- Chronic Illness Management
Background:
- Interfacility transfers are common for children with complex chronic conditions (CCCs).
- The impact of these transfers on health outcomes requires thorough investigation.
Purpose of the Study:
- To describe interfacility transfer patterns in pediatric CCC hospitalizations.
- To determine the association between interfacility transfer and key health outcomes.
Main Methods:
- Retrospective cohort study using the 2012 Kids' Inpatient Database.
- Identification of CCC hospitalizations using ICD-9 codes.
- Statistical analysis (quasi-Poisson and logistic regression) to assess transfer impact on length of stay, critical care, and mortality.
Main Results:
- 13% of pediatric CCC hospitalizations involved interfacility transfer.
- Transferred patients had a 1.6x longer length of stay.
- Transferred patients were 3x more likely to receive critical care and 3.6x more likely to experience in-hospital mortality.
Conclusions:
- Interfacility transfer is a significant factor in pediatric CCC hospitalizations.
- Transfers are associated with increased length of stay, critical care utilization, and mortality.
- Further research into clinical and logistical factors influencing transfer outcomes is warranted.
Objectives:
To describe interfacility transfers among children with complex chronic conditions (CCCs) and determine if interfacility transfer was associated with health outcomes. We hypothesized that interfacility transfer would be associated with length of stay (LOS), receipt of critical care services, and in-hospital mortality.
Methods:
In this retrospective cohort study, we used data from the 2012 Kids' Inpatient Database. CCC hospitalizations were identified by International Classification of Diseases, Ninth Revision codes. Receipt of critical care services was inferred by using International Classification of Diseases, Ninth Revision diagnosis and procedure codes. We performed a descriptive analysis of CCC hospitalizations then determined if transfer was associated with LOS, mortality, or receipt of critical care services using survey-adapted quasi-Poisson or logistic regression models, controlling for hospital and patient demographics.
Results:
There were 551 974 non-birth hospitalizations with at least 1 CCC diagnosis code. Of these, 13% involved an interfacility transfer. Compared with patients with CCCs who were not transferred, patients with CCCs who were transferred in and ultimately discharged from the receiving hospital had an adjusted LOS rate ratio of 1.6 (95% confidence interval [CI]: 1.5-1.7; P < .001), were more likely to have received critical care services (adjusted odds ratio 3.0; 95% CI: 2.7-3.2; P < .001), and had higher in-hospital mortality (adjusted odds ratio 3.6; 95% CI: 3.2-3.9; P < .001) (controlling for patient and hospital characteristics).
Conclusions:
Many hospitalizations for children with CCCs involve interfacility transfer. Compared with in-house admissions, hospitalizations of patients who are transferred in and ultimately discharged from the receiving hospital involve longer LOS, greater odds of receipt of critical care services, and in-hospital mortality. Further evaluation of the role of clinical and transfer logistic factors is needed to improve outcomes.
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