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A proposed method for identifying Interfacility transfers in Medicare claims data
Sayeh Nikpay1, Michelle Leeberg2, Katy Kozhimannil1
1Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, Minnesota, USA.
Objective:
To develop a method of consistently identifying interfacility transfers (IFTs) in Medicare Claims using patients with ST-Elevation Myocardial Infarction (STEMI) as an example.
Data Sources/Study Setting:
100% Medicare inpatient and outpatient Standard Analytic Files and 5% Carrier Files, 2011-2020.
Study Design:
Observational, cross-sectional comparison of patient characteristics between proposed and existing methods.
Data Collection/Extraction Methods:
We limited to patients aged 65+ with STEMI diagnosis using both proposed and existing methods.
Principal Findings:
We identified 62,668 more IFTs using the proposed method (86,128 versus 23,460). A separately billable interfacility ambulance trip was found for more IFTs using the proposed than existing method (86% vs. 79%). Compared with the existing method, transferred patients under the proposed method were more likely to live in rural (p < 0.001) and lower income (p < 0.001) counties and were located farther away from emergency departments, trauma centers, and intensive care units (p < 0.001).
Conclusions:
Identifying transferred patients based on two consecutive inpatient claims results in an undercount of IFTs and under-represents rural and low-income patients.
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