PDF(Pubmed)
Abstract：
UNASSIGNED: Intracranial hemorrhages present across a spectrum of clinical phenotypes, with many patients transferred across hospitals to access higher levels of neurocritical care. We sought to characterize patient dispositions following intracranial hemorrhage and examine disparities associated with interhospital transfers.
UNASSIGNED: Using the Healthcare Cost and Utilization Project database, we mapped and identified factors influencing the likelihood of patient transfers and receipt of specialist interventional procedures following intracranial hemorrhage.
UNASSIGNED: Of 11,660 patients with intracranial hemorrhage, 59.4% had non-traumatic and 87.5% single compartment bleeds. After presentation, about a quarter of patients were transferred to another facility either directly from the ED (23.0%) or after inpatient admission (1.8%). On unadjusted analysis, patients who were white, in the upper income quartiles, with private insurance, or resided in suburban areas were more frequently transferred. After adjusting for patient-and hospital-level variables, younger and non-white patients had higher odds of transfer. Hospital capabilities, residence location, insurance status, and prior therapeutic relationship remained as transfer predictors. Transferred patients had a similar hospital length of stay compared to admitted patients, with 43.1% having no recorded surgical or specialist interventional procedure after transfer.
UNASSIGNED: Our analysis reveals opportunities for improvement in risk stratification guiding transfers, as well as structural challenges likely impacting transfer decisions.
UNASSIGNED: Using the Healthcare Cost and Utilization Project database, we mapped and identified factors influencing the likelihood of patient transfers and receipt of specialist interventional procedures following intracranial hemorrhage.
UNASSIGNED: Of 11,660 patients with intracranial hemorrhage, 59.4% had non-traumatic and 87.5% single compartment bleeds. After presentation, about a quarter of patients were transferred to another facility either directly from the ED (23.0%) or after inpatient admission (1.8%). On unadjusted analysis, patients who were white, in the upper income quartiles, with private insurance, or resided in suburban areas were more frequently transferred. After adjusting for patient-and hospital-level variables, younger and non-white patients had higher odds of transfer. Hospital capabilities, residence location, insurance status, and prior therapeutic relationship remained as transfer predictors. Transferred patients had a similar hospital length of stay compared to admitted patients, with 43.1% having no recorded surgical or specialist interventional procedure after transfer.
UNASSIGNED: Our analysis reveals opportunities for improvement in risk stratification guiding transfers, as well as structural challenges likely impacting transfer decisions.
摘要：
■颅内出血出现在一系列临床表型中，许多患者通过医院转移到更高水平的神经重症监护。我们试图描述颅内出血后患者的处置特征，并检查与医院间转移相关的差异。
■使用医疗保健成本和利用率项目数据库，我们绘制并确定了影响颅内出血后患者转移和接受专科介入治疗的可能性的因素.
■在11,660例颅内出血患者中，59.4%为非创伤性出血，87.5%为单室出血。介绍之后,约1/4的患者直接从急诊科(23.0%)或在住院后(1.8%)转入另一治疗机构.在未调整的分析中，白人患者，在高收入四分位数中，私人保险,或居住在郊区的人更频繁地转移。在调整了患者和医院层面的变量后，年轻和非白人患者的转移几率较高.医院能力,居住地点,保险状况,和先前的治疗关系仍然是转移预测因子。与入院患者相比，转移患者的住院时间相似，43.1％的患者在转移后没有记录的手术或专科介入程序。
■我们的分析揭示了风险分层指导转移的改进机会，以及可能影响转让决策的结构性挑战。
■使用医疗保健成本和利用率项目数据库，我们绘制并确定了影响颅内出血后患者转移和接受专科介入治疗的可能性的因素.
■在11,660例颅内出血患者中，59.4%为非创伤性出血，87.5%为单室出血。介绍之后,约1/4的患者直接从急诊科(23.0%)或在住院后(1.8%)转入另一治疗机构.在未调整的分析中，白人患者，在高收入四分位数中，私人保险,或居住在郊区的人更频繁地转移。在调整了患者和医院层面的变量后，年轻和非白人患者的转移几率较高.医院能力,居住地点,保险状况,和先前的治疗关系仍然是转移预测因子。与入院患者相比，转移患者的住院时间相似，43.1％的患者在转移后没有记录的手术或专科介入程序。
■我们的分析揭示了风险分层指导转移的改进机会，以及可能影响转让决策的结构性挑战。
