title: Monitoring interhospital transfers in Western Greece during 2003-2011: its role in health policy.
abstract: BACKGROUND
  Interhospital transfers (ITs) could provide insight into regional healthcare efficiency and evidence for policy-making. The aim of this study was to analyse ITs carried out in the Western Greece region over a nine-year period.
  
  
  METHODS
  Archives of the National Center of Emergency Medical Services of Patras and official healthcare resources were used to analyze patient transfers from rural to 'reception' hospitals in the area, during the period 2003-2011, by hospital, medical, seasonal and population variations.
  
  
  RESULTS
  A total of 2500 ITs from the eight rural hospitals to the central ones in the metropolitan area of Patras were monitored yearly. Transfer rates per population ranged between less than 0.3% and more than 1.0%. Only a few patients transferred outside the area (0.9%). Almost 10% of total transfers regarded diagnostic evaluation (mostly CT scan). Transfer rates were inversely related to hospital admission rates (Pearson -0.973, p=0.027), while time (in minutes) (Pearson -0.903, =0.036) and distance (in kilometers) between the rural and central hospitals (Pearson -0.907, p=0.034) also exhibited significant relationships. The level of understaffing does not have a clear effect on ITs.
  
  
  CONCLUSIONS
  By monitoring ITs, it becomes evident where efforts should be prioritized and which of the interconnections should be optimized in a specific network of health care. In this case, interventions should be focused towards the (a) very high transfer rates from the general hospital (GH) of Aigio, (b) lack of orthopedists at GH Kalavryta, which could provide a 24 hour emergency service in a tourist ski area, (c) understaffing in the microbiological laboratory and lack of a CT scanner at GH Mesologi, and (d) lack of radiologists in several hospitals, rendering the installed equipment worthless. By monitoring the ITs, real needs and win-win actions may emerge in the complex interplay of infrastructural factors.
authors.affiliation: Occupational Health Unit, Onassis Cardiac Surgery Center, Greece. ecalexop@med.uoa.gr.
authors.forename: Evangelos C
authors.initials: EC
authors.lastname: Alexopoulos
authors.affiliation: Hellenic Open University, School of Social Sciences, Patras, Greece. ninskal@yahoo.gr.
authors.forename: Athanasia
authors.initials: A
authors.lastname: Kalyva
authors.affiliation: General Hospital of Patras, General Medicine Department, Patras, Greece. gmerek@upatras.gr.
authors.forename: Georgios
authors.initials: G
authors.lastname: Merekoulias
authors.affiliation: Hellenic Open University, School of Social Sciences, Patras, Greece. dimitrisniakas@ath.forthnet.gr.
authors.forename: Dimitris
authors.initials: D
authors.lastname: Niakas
mesh_terms: D015331:Cohort Studies; D016208:Databases, Factual; D004632:Emergency Medical Services / Q000458:organization & administration; D005260:Female; D006115:Greece; D006291:Health Policy; D006780:Hospitals, Rural; D006785:Hospitals, University; D006786:Hospitals, Urban; D006801:Humans; D015994:Incidence; D008297:Male; D015999:Multivariate Analysis; D010360:Patient Transfer; D011787:Quality of Health Care; D012044:Regression Analysis; D012189:Retrospective Studies; D012380:Role; D014187:Transportation of Patients / Q000458:organization & administration*
keywords: Administrator; Determinants of Health; Emergency Care; Europe; Health Needs Assessment; Health Promotion; Health Scientist; Health Service reform; Management/Administration; Medical; Nursing; Primary Health Care; Public Health