title: Discordance Between Patient and Clinician Experiences and Priorities in Rural Interhospital Transfer: A Mixed Methods Study.
abstract: OBJECTIVE
  Rural emergency department (ED) patients require interhospital transfer for definitive care at nearly 6 times the national rate, yet transfer decision-making is variable. The goal of this study was to understand patient experiences, preferences, and decision-making in the rural interhospital transfer process, and to measure the concordance between patient opinions and provider perceptions.
  
  
  METHODS
  Ours is a mixed methods study of patients transferred to a 711-bed Midwestern academic medical center and the emergency physicians in community hospitals. Qualitative interviews were conducted by a single research assistant with admitted patients transferred from an ED, and a corresponding survey was distributed to community emergency physicians. Standardized scenarios were posed to both groups to understand transfer priorities.
  
  
  RESULTS
  Seventy-nine patients and 40 physicians participated in this study. Patients and physicians cited proximity to home, medical expertise, a personal relationship with a health care provider, health insurance, privacy concerns, and patient choice as the primary factors that influenced patient transfer priorities. Compared with patient respondents, physicians overestimated the patient-perceived importance of proximity to home (P = .015) and being cared for by a personal physician (P = .049), but they underestimated the value of receiving treatment in a comprehensive medical center (P = .002). In standardized scenarios, physicians agreed with patients in transfer preferences for conditions requiring neurosurgical consultation, but they underestimated patients' desire for transfer for pneumonia requiring mechanical ventilation.
  
  
  CONCLUSIONS
  Patients and physicians recognize similar factors that influence patient preferences in interhospital ED transfer, but physicians may overestimate the value of nonmedical influences on decision-making priorities.
authors.affiliation: Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa.|Division of Critical Care, Department of Anesthesia, University of Iowa Carver College of Medicine, Iowa City, Iowa.
authors.forename: Nicholas M
authors.initials: NM
authors.lastname: Mohr
authors.affiliation: Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa.
authors.forename: Terrence S
authors.initials: TS
authors.lastname: Wong
authors.affiliation: Department of Pharmaceutical Care, University of Iowa Hospitals and Clinics, Iowa City, Iowa.
authors.forename: Brett
authors.initials: B
authors.lastname: Faine
authors.affiliation: Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa.|Division of Pulmonary, Critical Care, and Occupational Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa.
authors.forename: Adam
authors.initials: A
authors.lastname: Schlichting
authors.affiliation: Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa.
authors.forename: Joseph
authors.initials: J
authors.lastname: Noack
authors.affiliation: Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa.
authors.forename: Azeemuddin
authors.initials: A
authors.lastname: Ahmed
mesh_terms: D001291:Attitude of Health Personnel; D005260:Female; D006302:Health Services Research; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care; D010358:Patient Participation / Q000706:statistics & numerical data*; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D010360:Patient Transfer / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D014505:Urban Population / Q000706:statistics & numerical data*
keywords: access to care; hospitals; medical care; satisfaction with care; utilization of health services