The cost of transfer patients at an academic medical center Pubblico
Budde, Julia Marie (2012)
Abstract
Background
Interhospital transfer patients are known to have higher lengths of
stay, costs, and mortality than
direct admissions after adjusting for severity of illness and other
demographic factors. What is
not well-studied is the difference in costs between patients
transferred from an outside facility's
emergency department compared to transferred from an outside
facility's inpatient ward or ICU.
The purpose of this study is to determine whether the location of a
patient before transfer, i.e. ED
or inpatient, affects the total cost of hospitalization at the
receiving facility.
Methods
The study population included 31,415 hospital admissions to an
academic medical center in the
southeastern United States from November 1, 2009 through March 20,
2011. The primary
exposure was source of admission: directly through the emergency
department, transferred from
an outside emergency department, or transferred from inpatient
status at an outside hospital,
including ICU's and regular beds. The outcome measure was the total
cost of admission after
adjusting for age, gender, race, severity of illness, weekend
admission, and insurance type.
Results
There were 27,565 direct admissions, 1841 ED transfers, and 2009
inpatient transfers in the
study. The groups were statistically significantly different in
age, gender, race, severity of illness,
weekend admissions, and insurance type. After adjusting for all
these factors, the total cost of an
admission was different between the three sources of admission. ED
transfers had a higher
adjusted total cost than direct admissions (difference=$7,874, 95%
CI $6,615, $9,133; p<.0001).
Likewise, inpatient transfers cost $10,032 (95% CI $8,832, $11,232;
p<.0001) more than direct
admissions and $2,158 (95% CI $508, $3,807; p=0.0104) more than ED
transfers.
Conclusion
Transfer patients have a higher total cost of admission than do
directly-admitted patients, and
inpatient transfers are more costly than emergency department
transfers, even after accounting for
age, gender, race, severity of illness, weekend transfers, and
insurance type. Policy makers
should consider the financial burden to hospitals with specialized
capabilities when considering
expanding legislation that requires these hospitals to accept a
broader base of transfer patients.
Table of Contents
Table of Contents
Manuscript: The cost of transfer patients at an academic medical
center........................................ 1
Methods..............................................................................................................................
4
Results
...............................................................................................................................
6
Conclusion...........................................................................................................................
8
References
.........................................................................................................................
12
Tables
...............................................................................................................................
14
Table 1. Characteristics of total cohort and by source
................................................................
14
Table 2. Unadjusted relationship between predictor variables and
total cost ................................... 15
Table 3. Unadjusted and adjusted average total cost by source
................................................... 16
Table 4. Difference in unadjusted and adjusted total cost between
sources ................................... 16
Table 5. Sensitivity analysis for inpatient transfers
....................................................................
16
Appendix 1. Evaluating for Sampling
Bias...................................................................................
17
Table A1. Demographics of study subjects compared to excluded
subjects ..................................... 19
IRB Approval Letter
..............................................................................................................
20
About this Master's Thesis
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