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Hospital Factors Associated With Interhospital Transfer Destination for Stroke in the Northeast United States

BACKGROUND: We aimed to determine if there is an association between hospital quality and the likelihood of a given hospital being a preferred transfer destination for stroke patients. METHODS AND RESULTS: Data from Medicare claims identified acute ischemic stroke transferred between 394 northeast U...

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Autores principales: Zachrison, Kori S., Onnela, Jukka‐Pekka, Reeves, Mathew J., Hernandez, Adrian, Camargo, Carlos A., Zhao, Xin, Matsouaka, Roland A., Goldstein, Joshua N., Metlay, Joshua P., Schwamm, Lee H.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6988147/
https://www.ncbi.nlm.nih.gov/pubmed/31888430
http://dx.doi.org/10.1161/JAHA.118.011575
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author Zachrison, Kori S.
Onnela, Jukka‐Pekka
Reeves, Mathew J.
Hernandez, Adrian
Camargo, Carlos A.
Zhao, Xin
Matsouaka, Roland A.
Goldstein, Joshua N.
Metlay, Joshua P.
Schwamm, Lee H.
author_facet Zachrison, Kori S.
Onnela, Jukka‐Pekka
Reeves, Mathew J.
Hernandez, Adrian
Camargo, Carlos A.
Zhao, Xin
Matsouaka, Roland A.
Goldstein, Joshua N.
Metlay, Joshua P.
Schwamm, Lee H.
author_sort Zachrison, Kori S.
collection PubMed
description BACKGROUND: We aimed to determine if there is an association between hospital quality and the likelihood of a given hospital being a preferred transfer destination for stroke patients. METHODS AND RESULTS: Data from Medicare claims identified acute ischemic stroke transferred between 394 northeast US hospitals from 2007 to 2011. Hospitals were categorized as transferring (n=136), retaining (n=241), or receiving (n=17) hospitals based on the proportion of acute ischemic stroke encounters transferred or received. We identified all 6409 potential dyads of sending and receiving hospitals, and categorized dyads as connected if ≥5 patients were transferred between the hospitals annually (n=82). We used logistic regression to identify hospital characteristics associated with establishing a connected dyad, exploring the effect of adjusting for different quality measures and outcomes. We also adjusted for driving distance between hospitals, receiving hospital stroke volume, and the number of hospitals in the receiving hospital referral region. The odds of establishing a transfer connection increased when rate of alteplase administration increased at the receiving hospital or decreased at the sending hospital, however this finding did not hold after applying a potential strategy to adjust for clustering. Receiving hospital performance on 90‐day home time was not associated with likelihood of transfer connection. CONCLUSIONS: Among northeast US hospitals, we found that differences in hospital quality, specifically higher levels of alteplase administration, may be associated with increased likelihood of being a transfer destination. Further research is needed to better understand acute ischemic stroke transfer patterns to optimize stroke transfer systems.
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spelling pubmed-69881472020-02-03 Hospital Factors Associated With Interhospital Transfer Destination for Stroke in the Northeast United States Zachrison, Kori S. Onnela, Jukka‐Pekka Reeves, Mathew J. Hernandez, Adrian Camargo, Carlos A. Zhao, Xin Matsouaka, Roland A. Goldstein, Joshua N. Metlay, Joshua P. Schwamm, Lee H. J Am Heart Assoc Original Research BACKGROUND: We aimed to determine if there is an association between hospital quality and the likelihood of a given hospital being a preferred transfer destination for stroke patients. METHODS AND RESULTS: Data from Medicare claims identified acute ischemic stroke transferred between 394 northeast US hospitals from 2007 to 2011. Hospitals were categorized as transferring (n=136), retaining (n=241), or receiving (n=17) hospitals based on the proportion of acute ischemic stroke encounters transferred or received. We identified all 6409 potential dyads of sending and receiving hospitals, and categorized dyads as connected if ≥5 patients were transferred between the hospitals annually (n=82). We used logistic regression to identify hospital characteristics associated with establishing a connected dyad, exploring the effect of adjusting for different quality measures and outcomes. We also adjusted for driving distance between hospitals, receiving hospital stroke volume, and the number of hospitals in the receiving hospital referral region. The odds of establishing a transfer connection increased when rate of alteplase administration increased at the receiving hospital or decreased at the sending hospital, however this finding did not hold after applying a potential strategy to adjust for clustering. Receiving hospital performance on 90‐day home time was not associated with likelihood of transfer connection. CONCLUSIONS: Among northeast US hospitals, we found that differences in hospital quality, specifically higher levels of alteplase administration, may be associated with increased likelihood of being a transfer destination. Further research is needed to better understand acute ischemic stroke transfer patterns to optimize stroke transfer systems. John Wiley and Sons Inc. 2019-12-31 /pmc/articles/PMC6988147/ /pubmed/31888430 http://dx.doi.org/10.1161/JAHA.118.011575 Text en © 2019 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley. This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
spellingShingle Original Research
Zachrison, Kori S.
Onnela, Jukka‐Pekka
Reeves, Mathew J.
Hernandez, Adrian
Camargo, Carlos A.
Zhao, Xin
Matsouaka, Roland A.
Goldstein, Joshua N.
Metlay, Joshua P.
Schwamm, Lee H.
Hospital Factors Associated With Interhospital Transfer Destination for Stroke in the Northeast United States
title Hospital Factors Associated With Interhospital Transfer Destination for Stroke in the Northeast United States
title_full Hospital Factors Associated With Interhospital Transfer Destination for Stroke in the Northeast United States
title_fullStr Hospital Factors Associated With Interhospital Transfer Destination for Stroke in the Northeast United States
title_full_unstemmed Hospital Factors Associated With Interhospital Transfer Destination for Stroke in the Northeast United States
title_short Hospital Factors Associated With Interhospital Transfer Destination for Stroke in the Northeast United States
title_sort hospital factors associated with interhospital transfer destination for stroke in the northeast united states
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6988147/
https://www.ncbi.nlm.nih.gov/pubmed/31888430
http://dx.doi.org/10.1161/JAHA.118.011575
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