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Racial and Geographic Disparities in Interhospital ICU Transfers

Tyler, Patrick D. and Stone, David J. and Geisler, Benjamin P. and McLennan, Stuart and Celi, Leo Anthony and Rush, Barret. (2017) Racial and Geographic Disparities in Interhospital ICU Transfers. Critical Care Medicine.

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Abstract

OBJECTIVES:
Interhospital transfer, a common intervention, may be subject to healthcare disparities. In mechanically ventilated patients with sepsis, we hypothesize that disparities not disease related would be found between patients who were and were not transferred.
DESIGN:
Retrospective cohort study.
SETTING:
Nationwide Inpatient Sample, 2006-2012.
PATIENTS:
Patients over 18 years old with a primary diagnosis of sepsis who underwent mechanical ventilation.
INTERVENTIONS:
None.
MEASUREMENTS AND MAIN RESULTS:
We obtained age, gender, length of stay, race, insurance coverage, do not resuscitate status, and Elixhauser comorbidities. The outcome used was interhospital transfer from a small- or medium-sized hospital to a larger acute care hospital. Of 55,208,382 hospitalizations, 46,406 patients met inclusion criteria. In the multivariate model, patients were less likely to be transferred if the following were present: older age (odds ratio, 0.98; 95% CI, 0.978-0.982), black race (odds ratio, 0.79; 95% CI, 0.70-0.89), Hispanic race (odds ratio, 0.79; 95% CI, 0.69-0.90), South region hospital (odds ratio, 0.79; 95% CI, 0.72-0.88), teaching hospital (odds ratio, 0.31; 95% CI, 0.28-0.33), and do not resuscitate status (odds ratio, 0.19; 95% CI, 0.15-0.25).
CONCLUSIONS:
In mechanically ventilated patients with sepsis, we found significant disparities in race and geographic location not explained by medical diagnoses or illness severity.
Faculties and Departments:08 Cross-disciplinary Subjects > Ethik > Institut für Bio- und Medizinethik > Bio- und Medizinethik (Elger)
03 Faculty of Medicine > Departement Public Health > Ethik in der Medizin > Bio- und Medizinethik (Elger)
UniBasel Contributors:Mc Lennan, Stuart Roger
Item Type:Article, refereed
Article Subtype:Research Article
Publisher:Lippincott, Williams & Wilkins
ISSN:0090-3493
e-ISSN:1530-0293
Note:Publication type according to Uni Basel Research Database: Journal article
Language:English
Identification Number:
Last Modified:15 Jun 2018 08:15
Deposited On:17 Nov 2017 09:21

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