Stroke Patients Transferred to Another Hospital Are Younger and Sicker

MedicalResearch.com Interview with:

Mathew J. Reeves, PhD  Department of Epidemiology and Biostatistics Michigan State University East Lansing, MI

Dr. Mat Reeves

Mathew J. Reeves, PhD
Department of Epidemiology and Biostatistics
Michigan State University
East Lansing, MI 

MedicalResearch.com: What is the background for this study? What are the main findings?

Dr. Reeves:
  The transfer of stroke patients with ischemic stroke to primary and comprehensive stroke centers so they can receive specialized care including tPA (thrombolysis) and endovascular (catheter based) care is becoming increasingly important with the release or trial data showing substantial benefit for endovascular treatment in eligible patients.

  A major goal of integrated stroke systems of care is to ensure that stroke patients requiring specialized care beyond the capability of the initial hospital are identified and transferred to a specialist center as quickly as possible.

  Surprisingly, there is relatively little written about the frequency and outcomes of stroke patients who are transferred between hospitals, especially in the context of large quality improvement registries such as the Coverdell Stroke Registry or Get-With-The- Guidelines- Stroke

MedicalResearch.com: What should clinicians and patients take away from your report?

Response:

  Transferred cases were younger, had greater stroke severity, and were more likely to have hemorrhagic stroke.

  Transferred cases had higher in-hospital mortality and complication rates compared to regular admissions.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Dr. Reeves: In order to measures the relative benefits and potential harms of transferring patients, we need a more robust data system to track transferred cases, to determine the factors associated with the decision to transfer, and to measure patient outcomes.

MedicalResearch.com: Is there anything else you would like to add?

Response: How transfer cases are accounted for has important implications for measuring hospital quality and ranking. The fact that transfer status was associated with poor outcomes even after adjusting for stroke severity suggests that transfer status should be included in risk adjustment models designed to profile hospital performance. 

MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.

Citation:

Characteristics and Outcomes of Stroke Patients Transferred to Hospitals Participating in the Michigan Coverdell Acute Stroke Registry

  • Adrienne V. Nickles, Stacey Roberts, Erin Shell, Marylou Mitchell, Syed Hussain, Sarah Lyon-Callo, and Mathew J. Reeves

Circ Cardiovasc Qual Outcomes.2016;CIRCOUTCOMES.115.002388published online before print April 12 2016, doi:10.1161/CIRCOUTCOMES.115.002388

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