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Does interhospital transfer improve outcome of acute myocardial infarction? A propensity score analysis from the Cardiovascular Cooperative Project
Quantitative Health Sciences Publications and Presentations
  • John M. Westfall, University of Colorado
  • Catarina I. Kiefe, University of Massachusetts Medical School
  • Norman W. Weissman, University of Alabama
  • Anthony Goudie, University of Alabama
  • Robert M. Centor, University of Alabama
  • O. Dale Williams, University of Alabama
  • Jeroan J. Allison, University of Massachusetts Medical School
UMMS Affiliation
Department of Quantitative Health Sciences
Date
9-11-2008
Document Type
Article
Medical Subject Headings
Aged; Female; *Hospitals, Rural; *Hospitals, Urban; Humans; Male; Medicare; Myocardial Infarction; *Outcome and Process Assessment (Health Care); *Patient Transfer; Retrospective Studies; Time Factors; Treatment Outcome; United States
Abstract

BACKGROUND: Many patients suffering acute myocardial infarction (AMI) are transferred from one hospital to another during their hospitalization. There is little information about the outcomes related to interhospital transfer. The purpose of this study was to compare processes and outcomes of AMI care among patients undergoing interhospital transfer with special attention to the impact on mortality in rural hospitals.

METHODS: National sample of Medicare patients in the Cooperative Cardiovascular Study (n = 184,295). Retrospective structured medical record review of AMI hospitalizations. Descriptive study using a retrospective propensity score analysis of clinical and administrative data for 184,295 Medicare patients admitted with clinically confirmed AMI to 4,765 hospitals between February 1994 and July 1995. Main outcome measure included: 30-day mortality, administration of aspirin, beta-blockers, ACE-inhibitors, and thrombolytic therapy.

RESULTS: Overall, 51,530 (28%) patients underwent interhospital transfer. Transferred patients were significantly younger, less critically ill, and had lower comorbidity than non-transferred patients. After propensity-matching, patients who underwent interhospital transfer had better quality of care anlower mortality than non-transferred patients. Patients cared for in a rural hospital had similar mortality as patients cared for in an urban hospital.

CONCLUSION: Transferred patients were vastly different than non-transferred patients. However, even after a rigorous propensity-score analysis, transferred patients had lower mortality than non-transferred patients. Mortality was similar in rural and urban hospitals. Identifying patients who derive the greatest benefit from transfer may help physicians faced with the complex decision of whether to transfer a patient suffering an acute MI.

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Citation: BMC Cardiovasc Disord. 2008 Sep 9;8:22. Link to article on publisher's site
Related Resources
Link to Article in PubMed
Citation Information
John M. Westfall, Catarina I. Kiefe, Norman W. Weissman, Anthony Goudie, et al.. "Does interhospital transfer improve outcome of acute myocardial infarction? A propensity score analysis from the Cardiovascular Cooperative Project" Vol. 8 (2008) ISSN: 1471-2261 (Linking)
Available at: http://works.bepress.com/catarina_kiefe/121/