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. 2024 Jul 31:15:1409713.
doi: 10.3389/fneur.2024.1409713. eCollection 2024.

Interhospital transfer dynamics for patients with intracranial hemorrhage in Massachusetts

Ruchit V Patel #  1   2 , Lilin Tong #  1   3 , Bradley J Molyneaux  2   4 , Nirav J Patel  1   2 , Mohammed A Aziz-Sultan  1   2 , Amar Dhand  2   4 , Wenya Linda Bi  1   2
Affiliations

Interhospital transfer dynamics for patients with intracranial hemorrhage in Massachusetts

Ruchit V Patel et al. Front Neurol. .

Abstract

Introduction: 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.

Methods: 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.

Results: 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.

Discussion: Our analysis reveals opportunities for improvement in risk stratification guiding transfers, as well as structural challenges likely impacting transfer decisions.

Keywords: health infrastructure; healthcare systems; intracranial hemorrhage; patient transfers; socioeconomics.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Overview of patient cohort and transfer network. (A) Number of compartments affected by traumatic and non-traumatic intracranial hemorrhage. (B) Intracranial hemorrhage prevalence by bleed compartment. (C) Patient disposition following initial hospital presentation. (D) Locations and patient sending frequency of hospitals in Massachusetts. (E) Locations and patient receiving frequency of hospitals in Massachusetts. (F) Distribution of intracranial hemorrhage characteristics and trauma status for transferred versus admitted patients.
Figure 2
Figure 2
Patient and hospital level characteristics stratified by transfer versus admitted status. ADI, area deprivation index.
Figure 3
Figure 3
Analysis of factors influencing patient transfers and procedures following transfer. (A). Comparison of unadjusted and adjusted odds ratios for patient transfers following intracranial hemorrhage. (B). Frequency of interventional procedures for transferred versus admitted patients. (C). Distribution of hospital length for transferred versus admitted patients. (D). Multivariate adjusted odds ratio of receiving an intracranial procedure following transfer. (E). Multivariate adjusted odds ratio of receiving an intracranial procedure for patients admitted with intracranial hemorrhage. Red shading indicates odds ratios significant at p < 0.05. Prev.: previous, Net.: network.
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