Observational studyJournal of general internal medicine2018
Insurance Coverage Predicts Mortality in Patients Transferred Between Hospitals: a Cross-Sectional Study.
Observational study in Journal of general internal medicine, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers.
What it found
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
10 citing papers in PubMed.
- Hospital health information exchange participation and heart failure discharges to skilled nursing facilities: a cohort study.BMC health services research · 2025Article
- Article
- Interhospital Transfer of Patients With Acute Respiratory Failure in the United States: A Scoping Review.Critical care explorations · 2024Article
- Interfacility Transfer Outcomes Among Children With Complex Chronic Conditions: Associations Between Patient-Level and Hospital-Level Factors and Transfer Outcomes.Hospital pediatrics · 2024Article
- "It's Not That We Care Less": Insights into Health Care Utilization for Comorbid Diabetes and Depression among Latinos.International journal of environmental research and public health · 2024Article
- Process improvement using telemedicine consultation to prevent unnecessary interfacility transfers for low-severity blunt head trauma.BMJ open quality · 2023Article
- A nationwide retrospective analysis of ventilator-associated pneumonia in the US.Proceedings (Baylor University. Medical Center) · 2022Article
- Racial/Ethnic Disparities in Interhospital Transfer for Conditions With a Mortality Benefit to Transfer Among Patients With Medicare.JAMA network open · 2021Article
- Identifying Racial/Ethnic Disparities in Interhospital Transfer: an Observational Study.Journal of general internal medicine · 2020Observational
- Intensivists' Direct Management without Residents May Improve the Survival Rate Compared to High-Intensity Intensivist Staffing in Academic Intensive Care Units: Retrospective and Crossover Study Design.Journal of Korean medical science · 2020Article
Corrections and comments
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Authors and funding
7 authors.
Funding
Abstract
backgroundPatients transferred between hospitals are at high risk of adverse events and mortality. The relationship between insurance status, transfer practices, and outcomes has not been definitively characterized.
objectiveTo identify the association between insurance coverage and mortality of patients transferred between hospitals.
designWe conducted a single-institution observational study, and validated results using a national administrative database of inter-hospital transfers.
settingThree ICUs at an academic tertiary care center validated by a nationally representative sample of inter-hospital transfers. PATIENTS: The single-institution analysis included 652 consecutive patients transferred from 57 hospitals between 2011 and 2012. The administrative database included 353,018 patients transferred between 437 hospitals. MEASUREMENTS: Adjusted inpatient mortality and 24-h mortality, stratified by insurance status.
resultsOf 652 consecutive transfers to three ICUs, we observed that uninsured patients had higher adjusted inpatient mortality (OR 2.67, p = 0.021) when controlling for age, race, gender, Apache-II, and whether the patient was transferred from an ED. Uninsured were more likely to be transferred from ED (OR 2.3, p = 0.026), and earlier in their hospital course (3.9 vs 2.0 days, p = 0.002). Using an administrative dataset, we validated these observations, finding that the uninsured had higher adjusted inpatient mortality (OR 1.24, 95% CI 1.13-1.36, p < 0.001) and higher mortality within 24 h (OR 1.33 95% CI 1.11-1.60, p < 0.002). The increase in mortality was independent of patient demographics, referral patterns, or diagnoses. LIMITATIONS: This is an observational study where transfer appropriateness cannot be directly assessed.
conclusionsUninsured patients are more likely to be transferred from an ED and have higher mortality. These data suggest factors that drive inter-hospital transfer of uninsured patients have the potential to exacerbate outcome disparities.
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