Transfers of Hospitalized Patients and Insurance Status

Janel Hanmer, MD, PhD University of Pittsburgh Medical Center Montefiore Hospital Pittsburgh, PA Interview with:
Janel Hanmer, MD, PhD
University of Pittsburgh Medical Center
Montefiore Hospital
Pittsburgh, PA 15213 What are the main findings of the study?

Dr. Hanmer: We used the National Inpatient Sample – a sample of about 20% of US community hospitals with all discharges from those hospitals – to examine if insurance status is associated with transfer from one hospital to another. We were looking at patients who were already admitted to the hospital, not the patients who presented to the Emergency Department. We selected the five most common general medicine admissions for adults aged 18 to 64. We found that uninsured patients were less likely to be transferred than privately insured patients in four of the five conditions (about 20-40% less likely). We also found that women were less likely than men to be transferred in five of the conditions (about 35 to 40% less likely). Were any of the findings unexpected?

Dr. Hanmer: As clinicians, we expected that uninsured patients would be more likely to be transferred between hospitals because we expected hospitals to try to transfer unprofitable patients. Our study shows this did not happen. We also had no prior indication that women were less likely to be transfered than men. What should clinicians and patients take away from your report?

Dr. Hanmer: The data that we used for this study give a bird’s-eye view of transfers between hospitals. There are several places where this difference could originate. First, uninsured and female patients may not be requesting transfer as often as insured or male patients. Second, clinicians may not be recommending or initiating transfer as often for uninsured and female patients. Third, receiving hospitals may be putting up barriers to the transfer of uninsured and female patients. We need to tease apart these possible causes before we can give concrete recommendations to patients or clinicians. What recommendations do you have for future research as a result of this study?

Dr. Hanmer: We have several areas of research that we think are important:

1. Evaluating transfer rates of these different groups when we examine both the Emergency Department and the inpatient wards in combination. Prior research has suggested that the uninsured are more likely to be transferred from the Emergency Department.

2. Examining the timing and location of interventions. For instance, are uninsured patients more or less likely to receive an intervention before transfer when compared to an insured patient?

3. Examining the net effect of transfers on outcomes like mortality, complications, and length of stay. While we presume that transfers are generally a good thing (they provide access to subspecialty care and advanced treatments) they also expose patients to the risks of physically transferring between hospitals, a break in the continuity of care, and possibly to unnecessary tests and procedures.

Insurance Status and the Transfer of Hospitalized Patients: An Observational Study

Janel Hanmer, Xin Lu, Gary E. Rosenthal, Peter Cram; Insurance Status and the Transfer of Hospitalized PatientsAn Observational Study. Annals of Internal Medicine. 2014 Jan;160(2):81-90.

Last Updated on January 7, 2015 by Marie Benz MD FAAD