Abstract WMP31: National Trends in Transfer of Patients With Intracerebral Hemorrhage to Teaching Hospitals

Abstract

Introduction: The 2015 AHA guidelines for ICH management state that initial care of ICH patients should take place in an “ICU or a dedicated stroke unit with physician and nursing neuroscience acute care expertise”. This approach entails transferring ICH patients from community hospitals to centers with stroke expertise. Hypothesis: We explored national trends in transfer of ICH patients to teaching hospitals, and evaluated the differences in demographic, co-morbidity, resource utilization factors, and outcomes for transferred patients (TP) vs. directly admitted patients (DAP). Methods: From the National Inpatient Sample data for years 2006 to 2011, we identified patients with primary diagnosis of ICH (ICD-9 431). We assessed linear trends in the proportion of patients transferred over time using logistic regression. We constructed multivariate logistic regression models to explore the association of transfer status with inpatient mortality after controlling for significant factors. All analyses were performed using survey design variables, allowing us to report nationally-weighted estimates. Results: Our analysis subpopulation comprised of 232,009 patients, and 48,097 (20.7%, 95% CI: 17.8 - 23.9) were TP. There was a statistically significant increase in transfer over the 6 year period. (Figure 1). TP were younger, and were more likely to be white and have private insurance. The proportions of TP with hypertension, diabetes, congestive heart failure, and renal failure were also significantly smaller (Table 1). TP had lower adjusted odds of inpatient mortality as compared to DAP (Table 2). Conclusion: There is an increasing trend of transferring ICH patients to higher level of care. Care of transferred patients at specialized centers is associated with greater resource utilization and lower inpatient mortality. Evidence on optimal selection of patients benefiting from transfer, and long term functional outcomes are needed for policy planning.