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Inverse Probability of Treatment Weighting Propensity Score using the Military Health System Data Repository and National Death Index

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Oversight May Reduce Military Health System Leakage: Preventing Inappropriate Interhospital Transfers.

James Gragg¹, Ian Hudson², Vanessa Hannick¹

¹Department of Emergency Medicine, Carl R. Darnall Army Medical Center, Fort Hood, TX 76544, USA.

Military Medicine

|June 18, 2021

Summary

Implementing a Transfer Policy and Transfer Rounds significantly reduced inappropriate patient transfers within the Military Health System (MHS). This initiative improved patient care continuity and clinician practice scope, reducing emergency department (ED) wait times.

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Area of Science:

Healthcare Management
Clinical Operations
Health Services Research

Background:

The Military Health System (MHS) faces challenges with clinicians transferring patients to civilian hospitals, even when capable of in-house care.
This practice, known as MHS Leakage, can disrupt patient care continuity and strain resources.

Purpose of the Study:

To assess the impact of a new Transfer Policy Statement and Transfer Rounds on reducing patient transfers from a military medical center.
To evaluate the effectiveness of these initiatives in minimizing transfers for conditions treatable within the MHS.

Main Methods:

A retrospective chart review was conducted from July 2019 to June 2020.
The study analyzed total emergency department (ED) transfers, categorizing them by capability for in-house care.
Statistical analysis, including Cochran and Armitage trends, was used to assess changes in transfer rates post-intervention.

Main Results:

A total of 706 transfers were analyzed over the study period.
A statistically significant downward trend (P < .0001) was observed in the proportion of inappropriate transfers.
The interventions demonstrated a reduction in MHS Leakage.

Conclusions:

The Transfer Policy and Transfer Rounds effectively reduced unnecessary patient transfers within the MHS.
These initiatives enhance patient continuity of care, expand clinician scope of practice, and improve ED patient flow and wait times.
Further studies could explore the financial implications of reduced MHS Leakage.