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

2020-09-01T15:52:58Z

2020-09-01T15:52:58Z

2020-01

2020-09-01T15:52:57Z

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.

2047-9980

2047-9980

https://hdl.handle.net/10161/21405

eng

Ovid Technologies (Wolters Kluwer Health)

Journal of the American Heart Association

10.1161/jaha.118.011575

hospital quality

ischemic stroke

network analysis

patient transfer

systems of care

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

Journal article

Hernandez, Adrian|0000-0003-3387-9616

Matsouaka, Roland A|0000-0002-0271-5400

e011575

1

School of Medicine

Duke Clinical Research Institute

Biostatistics & Bioinformatics

Duke

Institutes and Centers

Basic Science Departments

Medicine, Cardiology

Medicine

Clinical Science Departments

Published

9