TY - JOUR
T1 - Racial and Geographic Disparities in Interhospital ICU Transfers
AU - Tyler, Patrick D.
AU - Stone, David J.
AU - Geisler, Benjamin P.
AU - McLennan, Stuart
AU - Celi, Leo Anthony
AU - Rush, Barret
PY - 2018/1/1
Y1 - 2018/1/1
N2 - Objectives: Interhospital transfer, a common intervention, may be subject to healthcare disparities. In mechanically ventilated patients with sepsis, we hypothesize that disparities not disease related would be found between patients who were and were not transferred. Design: Retrospective cohort study. Setting: Nationwide Inpatient Sample, 2006-2012. Patients: Patients over 18 years old with a primary diagnosis of sepsis who underwent mechanical ventilation. Interventions: None. Measurements and Main Results: We obtained age, gender, length of stay, race, insurance coverage, do not resuscitate status, and Elixhauser comorbidities. The outcome used was interhospital transfer from a small-or medium-sized hospital to a larger acute care hospital. Of 55,208,382 hospitalizations, 46,406 patients met inclusion criteria. In the multivariate model, patients were less likely to be transferred if the following were present: older age (odds ratio, 0.98; 95% CI, 0.978-0.982), black race (odds ratio, 0.79; 95% CI, 0.70-0.89), Hispanic race (odds ratio, 0.79; 95% CI, 0.69-0.90), South region hospital (odds ratio, 0.79; 95% CI, 0.72-0.88), teaching hospital (odds ratio, 0.31; 95% CI, 0.28-0.33), and do not resuscitate status (odds ratio, 0.19; 95% CI, 0.15-0.25). Conclusions: In mechanically ventilated patients with sepsis, we found significant disparities in race and geographic location not explained by medical diagnoses or illness severity.
AB - Objectives: Interhospital transfer, a common intervention, may be subject to healthcare disparities. In mechanically ventilated patients with sepsis, we hypothesize that disparities not disease related would be found between patients who were and were not transferred. Design: Retrospective cohort study. Setting: Nationwide Inpatient Sample, 2006-2012. Patients: Patients over 18 years old with a primary diagnosis of sepsis who underwent mechanical ventilation. Interventions: None. Measurements and Main Results: We obtained age, gender, length of stay, race, insurance coverage, do not resuscitate status, and Elixhauser comorbidities. The outcome used was interhospital transfer from a small-or medium-sized hospital to a larger acute care hospital. Of 55,208,382 hospitalizations, 46,406 patients met inclusion criteria. In the multivariate model, patients were less likely to be transferred if the following were present: older age (odds ratio, 0.98; 95% CI, 0.978-0.982), black race (odds ratio, 0.79; 95% CI, 0.70-0.89), Hispanic race (odds ratio, 0.79; 95% CI, 0.69-0.90), South region hospital (odds ratio, 0.79; 95% CI, 0.72-0.88), teaching hospital (odds ratio, 0.31; 95% CI, 0.28-0.33), and do not resuscitate status (odds ratio, 0.19; 95% CI, 0.15-0.25). Conclusions: In mechanically ventilated patients with sepsis, we found significant disparities in race and geographic location not explained by medical diagnoses or illness severity.
KW - healthcare delivery
KW - healthcare disparities
KW - interhospital transfer
KW - medical transport
KW - sepsis
UR - http://www.scopus.com/inward/record.url?scp=85038241282&partnerID=8YFLogxK
U2 - 10.1097/CCM.0000000000002776
DO - 10.1097/CCM.0000000000002776
M3 - Article
C2 - 29068859
AN - SCOPUS:85038241282
SN - 0090-3493
VL - 46
SP - e76-e80
JO - Critical Care Medicine
JF - Critical Care Medicine
IS - 1
ER -
