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Published on: August 7, 2017
Factors Associated With Potentially Unnecessary Transfers for Children With Asthma: A Retrospective Cohort Study
Gregory A Peters, Rebecca E Cash, Scott A Goldberg
1Department of Emergency Medicine, Massachusetts General Hospital.
Insights
Hospital and community factors influence unnecessary interfacility transfers (IFTs) for pediatric asthma patients. Higher pediatric volume and community vulnerability correlate with increased potentially unnecessary IFTs, highlighting care disparities.
Area of Science:
- Health Services Research
- Pediatric Emergency Medicine
- Health Equity
Background:
- Interfacility transfers (IFTs) are common for pediatric asthma exacerbations presenting to emergency departments (EDs).
- Potentially unnecessary IFTs may indicate system inefficiencies and contribute to health disparities.
Purpose of the Study:
- To identify hospital and community factors associated with the rate of potentially unnecessary IFTs for pediatric asthma patients.
- To understand drivers of variation in IFT practices across different healthcare settings and patient populations.
Main Methods:
- Analysis of California ED data (2016-2019) for pediatric asthma exacerbation visits requiring IFT.
- Defined potentially unnecessary IFTs by short length of stay (<24 hours) and absence of advanced services post-transfer.
- Utilized multivariable modified Poisson regression to assess associations between hospital/community characteristics and IFT rates.
Main Results:
- Nearly half of 325 included hospitals had a potentially unnecessary IFT rate.
- Factors associated with higher rates included availability of pediatric telehealth, increased pediatric patient volume, and higher community Social Vulnerability Index.
- Higher pediatric volume (≥10,000 visits) showed a 2.6-fold increased prevalence ratio for unnecessary IFTs.
Conclusions:
- Hospital and community factors significantly influence potentially unnecessary IFTs for pediatric asthma patients.
- Findings highlight potential disparities in care access and transfer appropriateness across diverse communities.
- Results can inform targeted interventions to optimize pediatric asthma care transitions and reduce unnecessary transfers.
Objective:
Our objective was to identify the hospital- and community-related factors associated with the hospital-level rate of potentially unnecessary interfacility transfers (IFTs) for pediatric patients with asthma exacerbations.
Methods:
We analyzed California Emergency Department (ED) data from 2016 to 2019 to capture ED visits where a pediatric patient (age, 2-17 years) presented with an asthma exacerbation and was transferred to another ED or acute care hospital. The primary outcome was hospital-level rate of potentially unnecessary IFTs, defined as a visit where length of stay after transfer was <24 hours and no advanced services (eg, critical care) were used. Hospital- and community-related characteristics included urbanicity, teaching hospital status, availability of pediatric resources in the sending facility and patient's community, pediatric patient volume, and Social Vulnerability Index. We described and compared hospitals in the top quartile of potentially unnecessary IFT rate versus all others and used a multivariable modified Poisson model to identify factors associated with potentially unnecessary IFT.
Results:
A total of 325 sending hospitals were included, with a median 573 pediatric asthma visits (interquartile range, 183-1309) per hospital annually. Nearly half of the hospitals (145/325, 45%) sent a potentially unnecessary IFT. Most (90%) hospitals were urban, 9% were teaching hospitals, 5% had >500 beds, and 22% had a pediatric ED on-site. Factors associated with higher adjusted prevalence of potentially unnecessary IFT included availability of pediatric telehealth (prevalence ratio [PR], 1.5; 95% confidence interval [CI], 1.2-2.0), increased pediatric volume (eg, <1800 vs ≥10,000 visits: PR, 2.6; 95% CI, 1.4-4.7), and higher community Social Vulnerability Index (PR, 1.5; 95% CI, 1.1-1.9).
Conclusions:
Several hospital- and community-related factors were associated with potentially unnecessary IFTs among pediatric patients presenting to the ED with asthma exacerbations. These findings provide insight into disparities in potentially unnecessary IFT across communities and can guide the development of future interventions.
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