title: Selection of a hospital for a transfer: the roles of patients, families, physicians and payers.
abstract: OBJECTIVE
  This study investigates the reasons for hospital transfers and the role patients, their families, physicians, and payers play in the choice of a referral center.
  
  
  METHODS
  A thirty-three item questionnaire and clinical data from the hospital's discharge database.
  
  
  METHODS
  A study of all 307 hospital transfer patients admitted between November 9 and December 3, 1993 was conducted to understand the factors contributing to the increase in transfers and the reasons patients were sent to CCH. Data on the transfer decision were collected by interviewing patients 48 hours after admittance to the hospital or by telephone if they were discharged before an interview could be completed. Two hundred and sixty-two (85%) patients were interviewed.
  
  
  RESULTS
  (1) Almost 58% of transfers were patient-initiated or -influenced; the remainder were physician- (38%) or payer-directed (4%); (2) More than 78% of the patients identified lack of clinical expertise/technology at originating hospital as the main reason for transferring. Other reasons included: established CCH patient status (43%), CCH marketing (31%), and concerns regarding quality of care at originating hospital (10%). Financial and quality dumping were not identified as reasons for the transfer. New patients to CCH were more likely to indicate that marketing and lack of clinical resources at originating hospital were reasons for selecting CCH than previous patients.
  
  
  CONCLUSIONS
  Patients significantly influenced the transfer decision and the transfer decision-making process can be influenced by marketing. The opinions of the consumer should not be underestimated, especially by those seeking non-marketing solutions to health care reform.
authors.affiliation: Cleveland Clinic Foundaton, OH 44195, USA.
authors.forename: W R
authors.initials: WR
authors.lastname: Gombeski
authors.forename: D
authors.initials: D
authors.lastname: Konrad
authors.forename: G
authors.initials: G
authors.lastname: Kanoti
authors.forename: S
authors.initials: S
authors.lastname: Ulreich
authors.forename: J
authors.initials: J
authors.lastname: Skilogianis
authors.forename: J
authors.initials: J
authors.lastname: Clough
mesh_terms: D000328:Adult; D000368:Aged; D003256:Community Participation; D003657:Decision Making; D005190:Family; D005260:Female; D006770:Hospitals, Group Practice / Q000706:statistics & numerical data*; D006801:Humans; D019458:Insurance Coverage; D008297:Male; D008389:Marketing of Health Services; D008875:Middle Aged; D009820:Ohio; D010360:Patient Transfer / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D017062:Small-Area Analysis; D011795:Surveys and Questionnaires