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The cost of transfer patients at an academic medical center

Budde, Julia Marie (2012)
Master's Thesis (28 pages)
Committee Chair / Thesis Adviser: McGowan Jr., John E
Committee Members: Gartland, Bryce D ; Tong, David
Research Fields: Health Sciences, Health Care Management; Health Sciences, Public Health
Partnering Agencies:
Keywords: transfer; Interhospital transfer; academic medical center; AMC; cost
Program: Rollins School of Public Health, Epidemiology (Epidemiology)
Permanent url: http://pid.emory.edu/ark:/25593/bng3h

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

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