title: Impact of institution of a stroke program upon referral bias at a rural academic medical center.
abstract: BACKGROUND
  Referral bias reflecting the preferential hospital transfer of patients with intracerebral hemorrhage (ICH) has been demonstrated as the major contributing factor for an observed high nonrisk-adjusted in-hospital crude acute stroke mortality rate at a rural academic medical center.
  
  
  OBJECTIVE
  This study was done to assess the impact of a clinical acute stroke program upon referral bias in August 2000.
  
  
  METHODS
  A chart review of acute stroke (DRG 14) discharges during 2001 from a rural academic medical center was compared with the same data from 1999.
  
  
  RESULTS
  The odds ratio of ICH in hospital-transfer patients compared with nonhospital-transfer patients decreased from 11.7 in 1999 to 3.2 in 2001 (P < .035).
  
  
  CONCLUSIONS
  This study demonstrated the rapid magnitude and significance that clinical programs can have upon referral bias. Changes in referral bias may be more rapid at rural academic medical centers because of the relative lack of health care delivery competition.
authors.affiliation: Department of Neurology, West Virginia University School of Medicine, Morgantown, WV 26506-9180, USA. jriggs@wvu.edu
authors.forename: Jack E
authors.initials: JE
authors.lastname: Riggs
authors.forename: David P
authors.initials: DP
authors.lastname: Libell
authors.forename: Claudette E
authors.initials: CE
authors.lastname: Brooks
authors.forename: Gerald R
authors.initials: GR
authors.lastname: Hobbs
mesh_terms: D000046:Academic Medical Centers / Q000592:standards / Q000706:statistics & numerical data*; D002543:Cerebral Hemorrhage / Q000145:classification / Q000401:mortality* / Q000628:therapy; D003953:Diagnosis-Related Groups; D017052:Hospital Mortality; D006780:Hospitals, Rural / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D016017:Odds Ratio; D010360:Patient Transfer / Q000706:statistics & numerical data*; D015397:Program Evaluation; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D018570:Risk Assessment; D015983:Selection Bias; D012720:Severity of Illness Index; D020521:Stroke / Q000145:classification / Q000401:mortality* / Q000628:therapy; D014903:West Virginia / Q000453:epidemiology