Skip to main content
Journal cover image

Influence of transfer-in rates on quality of care and outcomes at receiving hospitals in patients with non-ST-segment elevation myocardial infarction.

Publication ,  Journal Article
Mehta, RH; Chen, AY; Ohman, EM; Gibler, WB; Peterson, ED; Roe, MT; CRUSADE National Quality Improvement Initiative Investigators,
Published in: Am Heart J
September 2010

BACKGROUND: Patients with non-ST-segment elevation myocardial infarction (NSTEMI) are frequently transferred to tertiary hospitals for angiography and/or revascularization from hospitals lacking such capabilities. Given that patients who undergo invasive cardiac procedures are younger and have fewer comorbidities compared with those managed medically, the relative proportion of transfer-in patients at tertiary hospitals may influence comparisons of quality and guidelines adherence. METHODS: We evaluated 142,092 NSTEMI patients treated at 396 revascularization-capable sites in the CRUSADE National Quality Improvement Initiative from 2001 to 2006. Transfer-in patients were included if they arrived at the receiving hospital after their first presentation to a different hospital. Hospitals were categorized into tertiles based upon their transfer-in rates (low, intermediate, and high) and adherence to practice guidelines recommendations for NSTEMI. In-hospital clinical outcomes were compared across hospital tertiles. RESULTS: Acute and discharge composite guidelines adherence scores improved at hospitals with an increasing proportion of transfer-in patients, both for transferred as well as for directly admitted patients. These better adherence scores were inversely associated with overall mortality, with the lowest mortality observed in patients at hospitals with the highest transfer-in rates. However, once adjusted for baseline confounders, the mortality rates for patients in the hospitals in the highest transfer-in tertile did not differ significantly compared with the sites in the lowest transfer-in tertile (odds ratio 1.02, 95% CI 0.90-1.16). CONCLUSIONS: Our findings show that the proportion of NSTEMI patients transferred into revascularization-capable hospitals varies significantly. Hospitals with a higher proportion of transfer-in patients tend to provide higher overall quality of NSTE acute coronary syndrome care; they also have lower overall in-hospital mortality, which may, in part, be related to the lower-risk baseline characteristics of patients at these hospitals.

Duke Scholars

Published In

Am Heart J

DOI

EISSN

1097-6744

Publication Date

September 2010

Volume

160

Issue

3

Start / End Page

405 / 411

Location

United States

Related Subject Headings

  • United States
  • Quality of Health Care
  • Practice Guidelines as Topic
  • Patient Transfer
  • Outcome Assessment, Health Care
  • Myocardial Revascularization
  • Myocardial Infarction
  • Multicenter Studies as Topic
  • Middle Aged
  • Male
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Mehta, R. H., Chen, A. Y., Ohman, E. M., Gibler, W. B., Peterson, E. D., Roe, M. T., & CRUSADE National Quality Improvement Initiative Investigators, . (2010). Influence of transfer-in rates on quality of care and outcomes at receiving hospitals in patients with non-ST-segment elevation myocardial infarction. Am Heart J, 160(3), 405–411. https://doi.org/10.1016/j.ahj.2010.06.025
Mehta, Rajendra H., Anita Y. Chen, E Magnus Ohman, W Brian Gibler, Eric D. Peterson, Matthew T. Roe, and Matthew T. CRUSADE National Quality Improvement Initiative Investigators. “Influence of transfer-in rates on quality of care and outcomes at receiving hospitals in patients with non-ST-segment elevation myocardial infarction.Am Heart J 160, no. 3 (September 2010): 405–11. https://doi.org/10.1016/j.ahj.2010.06.025.
Mehta RH, Chen AY, Ohman EM, Gibler WB, Peterson ED, Roe MT, et al. Influence of transfer-in rates on quality of care and outcomes at receiving hospitals in patients with non-ST-segment elevation myocardial infarction. Am Heart J. 2010 Sep;160(3):405–11.
Mehta, Rajendra H., et al. “Influence of transfer-in rates on quality of care and outcomes at receiving hospitals in patients with non-ST-segment elevation myocardial infarction.Am Heart J, vol. 160, no. 3, Sept. 2010, pp. 405–11. Pubmed, doi:10.1016/j.ahj.2010.06.025.
Mehta RH, Chen AY, Ohman EM, Gibler WB, Peterson ED, Roe MT, CRUSADE National Quality Improvement Initiative Investigators. Influence of transfer-in rates on quality of care and outcomes at receiving hospitals in patients with non-ST-segment elevation myocardial infarction. Am Heart J. 2010 Sep;160(3):405–411.
Journal cover image

Published In

Am Heart J

DOI

EISSN

1097-6744

Publication Date

September 2010

Volume

160

Issue

3

Start / End Page

405 / 411

Location

United States

Related Subject Headings

  • United States
  • Quality of Health Care
  • Practice Guidelines as Topic
  • Patient Transfer
  • Outcome Assessment, Health Care
  • Myocardial Revascularization
  • Myocardial Infarction
  • Multicenter Studies as Topic
  • Middle Aged
  • Male