title: Does interhospital transfer improve outcome of acute myocardial infarction? A propensity score analysis from the Cardiovascular Cooperative Project.
abstract: BACKGROUND
  Many patients suffering acute myocardial infarction (AMI) are transferred from one hospital to another during their hospitalization. There is little information about the outcomes related to interhospital transfer. The purpose of this study was to compare processes and outcomes of AMI care among patients undergoing interhospital transfer with special attention to the impact on mortality in rural hospitals.
  
  
  METHODS
  National sample of Medicare patients in the Cooperative Cardiovascular Study (n = 184,295). Retrospective structured medical record review of AMI hospitalizations. Descriptive study using a retrospective propensity score analysis of clinical and administrative data for 184,295 Medicare patients admitted with clinically confirmed AMI to 4,765 hospitals between February 1994 and July 1995. Main outcome measure included: 30-day mortality, administration of aspirin, beta-blockers, ACE-inhibitors, and thrombolytic therapy.
  
  
  RESULTS
  Overall, 51,530 (28%) patients underwent interhospital transfer. Transferred patients were significantly younger, less critically ill, and had lower comorbidity than non-transferred patients. After propensity-matching, patients who underwent interhospital transfer had better quality of care anlower mortality than non-transferred patients. Patients cared for in a rural hospital had similar mortality as patients cared for in an urban hospital.
  
  
  CONCLUSIONS
  Transferred patients were vastly different than non-transferred patients. However, even after a rigorous propensity-score analysis, transferred patients had lower mortality than non-transferred patients. Mortality was similar in rural and urban hospitals. Identifying patients who derive the greatest benefit from transfer may help physicians faced with the complex decision of whether to transfer a patient suffering an acute MI.
authors.affiliation: University of Colorado Denver - Anschutz Medical Campus, Denver, Colorado, USA. jack.westfall@uchsc.edu
authors.forename: John M
authors.initials: JM
authors.lastname: Westfall
authors.forename: Catarina I
authors.initials: CI
authors.lastname: Kiefe
authors.forename: Norman W
authors.initials: NW
authors.lastname: Weissman
authors.forename: Anthony
authors.initials: A
authors.lastname: Goudie
authors.forename: Robert M
authors.initials: RM
authors.lastname: Centor
authors.forename: O Dale
authors.initials: OD
authors.lastname: Williams
authors.forename: Jeroan J
authors.initials: JJ
authors.lastname: Allison
mesh_terms: D000368:Aged; D005260:Female; D006780:Hospitals, Rural / Q000706:statistics & numerical data; D006786:Hospitals, Urban / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D006278:Medicare; D009203:Myocardial Infarction / Q000401:mortality / Q000628:therapy*; D010043:Outcome and Process Assessment, Health Care; D010360:Patient Transfer / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
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