title: Patient and Hospital Characteristics Associated with Interhospital Transfer for Adults with Ventilator-Dependent Respiratory Failure.
abstract: BACKGROUND
  Patients with ventilator-dependent respiratory failure have improved outcomes at centers with greater expertise; yet, most patients are not treated in such facilities. Efforts to align care for respiratory failure and hospital capability would necessarily require interhospital transfer.
  
  
  OBJECTIVE
  To characterize the prevalence and the patient and hospital factors associated with interhospital transfer of adults residing in Florida with ventilator-dependent respiratory failure.
  
  
  METHODS
  We performed a retrospective, observational study using Florida Healthcare Cost and Utilization Project data. We selected patients 18 years of age and older with International Classification of Diseases, Ninth Revision, codes of respiratory failure and mechanical ventilation during 2012 and 2013, and we identified cohorts of patients that did and did not undergo interhospital transfer. We obtained patient sociodemographic and clinical variables and categorized hospitals into subtypes on the basis of patient volume and services provided: large, medium (nonprofit or for-profit), and small.
  
  
  RESULTS
  Interhospital transfer was our primary outcome measure. Patient sociodemographics, clinical variables, and hospital types were used as covariates. We identified 2,580 patients with ventilator-dependent respiratory failure who underwent interhospital transfer. Overall, transfer was uncommon, with only 2.9% of patients being transferred. In a hierarchical model, age less than 65 years (odds ratio [OR], 2.09; 95% confidence interval [CI], 1.77-2.45) and tracheostomy (OR, 3.19; 95% CI, 2.80-3.65) were associated with higher odds of transfer, whereas having Medicaid was associated with lower odds of transfer than having commercial insurance (OR, 0.65; 95% CI, 0.56-0.75). Additionally, care in medium-sized for-profit hospitals was associated with lower odds of transfer (OR, 1.37 vs. 2.70) than care in medium nonprofit hospitals, despite similar hospital characteristics.
  
  
  CONCLUSIONS
  In Florida, interhospital transfer of patients with ventilator-dependent respiratory failure is uncommon and more likely among younger, commercially insured, medically resource-intensive patients. For-profit hospitals are less likely to transfer than nonprofit hospitals. In future studies, researchers should test for geographic variations and examine the clinical implications of selectivity in interhospital transfer of patients with ventilator-dependent respiratory failure.
authors.affiliation: 1 Division of Pulmonary and Critical Care Medicine, Department of Medicine, and.
authors.forename: Nandita R
authors.initials: NR
authors.lastname: Nadig
authors.affiliation: 1 Division of Pulmonary and Critical Care Medicine, Department of Medicine, and.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Goodwin
authors.affiliation: 2 Department of Healthcare Leadership and Management, Medical University of South Carolina, Charleston, South Carolina.
authors.forename: Annie N
authors.initials: AN
authors.lastname: Simpson
authors.affiliation: 2 Department of Healthcare Leadership and Management, Medical University of South Carolina, Charleston, South Carolina.
authors.forename: Kit N
authors.initials: KN
authors.lastname: Simpson
authors.affiliation: 1 Division of Pulmonary and Critical Care Medicine, Department of Medicine, and.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Richards
authors.affiliation: 1 Division of Pulmonary and Critical Care Medicine, Department of Medicine, and.
authors.forename: Dee W
authors.initials: DW
authors.lastname: Ford
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual; D005260:Female; D005431:Florida; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D008484:Medicaid; D008875:Middle Aged; D015999:Multivariate Analysis; D010360:Patient Transfer / Q000706:statistics & numerical data*; D012121:Respiration, Artificial; D012131:Respiratory Insufficiency / Q000628:therapy*; D012189:Retrospective Studies; D014481:United States
keywords: Healthcare Cost and Utilization Project; nonprofit status; profit status; state inpatient database