title: Migration of patients between five urban teaching hospitals in Chicago.
abstract: To quantify the extent of patient sharing and inpatient care fragmentation among patients discharged from a cohort of Chicago hospitals. Admission and discharge dates and patient ZIP codes from 5 hospitals over 2 years were matched with an encryption algorithm. Admission to more than one hospital was considered fragmented care. The association between fragmentation and socio-economic variables using ZIP-code data from the 2000 US Census was measured. Using validation from one hospital, patient matching using encrypted identifiers had a sensitivity of 99.3 % and specificity of 100 %. The cohort contained 228,151 unique patients and 334,828 admissions. Roughly 2 % of the patients received fragmented care, accounting for 5.8 % of admissions and 6.4 % of hospital days. In 3 of 5 hospitals, and overall, the length of stay of patients with fragmented care was longer than those without. Fragmentation varied by hospital and was associated with the proportion of non-Caucasian persons, the proportion of residents whose income fell in the lowest quartile, and the proportion of residents with more children being raised by mothers alone in the zip code of the patient. Patients receiving fragmented care accounted for 6.4 % of hospital days. This percentage is a low estimate for our region, since not all regional hospitals participated, but high enough to suggest value in creating Health Information Exchange. Fragmentation varied by hospital, per capita income, race and proportion of single mother homes. This secure methodology and fragmentation analysis may prove useful for future analyses.
authors: Department of Medicine, University of Illinois at Chicago (UIC), Chicago, USA, BillG@uic.edu.
authors: William L
authors: WL
authors: Galanter
authors: Andrew
authors: A
authors: Applebaum
authors: Viveka
authors: V
authors: Boddipalli
authors: Abel
authors: A
authors: Kho
authors: Michael
authors: M
authors: Lin
authors: David
authors: D
authors: Meltzer
authors: Anna
authors: A
authors: Roberts
authors: Bill
authors: B
authors: Trick
authors: Surrey M
authors: SM
authors: Walton
authors: Bruce L
authors: BL
authors: Lambert
mesh_terms: D002641:Chicago; D066275:Health Information Exchange; D006784:Hospitals, Teaching / Q000458:organization & administration*; D006786:Hospitals, Urban / Q000458:organization & administration; D006801:Humans; D007902:Length of Stay; D010343:Patient Admission; D010360:Patient Transfer / Q000458:organization & administration*; D010865:Pilot Projects; D011787:Quality of Health Care; D012923:Social Class
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