• Stephanie K Mueller, Jie Zheng, E John Orav, and Jeffrey L Schnipper.
• Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
• J Hosp Med. 2017 Jun 1; 12 (6): 435442435-442.

ImportanceInterhospital transfer (IHT) remains a largely unstudied process of care.ObjectiveTo determine the nationwide frequency of, patient and hospital-level predictors of, and hospital variability in IHT.DesignCross-sectional study.SettingCenters for Medicare and Medicaid 2013 100% Master Beneficiary Summary and Inpatient claims files merged with 2013 American Hospital Association data.PatientsBeneficiaries ≥65 years and older enrolled in Medicare A and B, with an acute care hospitalization claim in 2013.ExposuresPatient and hospital characteristics of transferred and nontransferred patients.MeasurementsFrequency of interhospital transfers (IHT); adjusted odds of transfer of each patient and each hospital characteristic; and variability in hospital transfer rates.ResultsOf 6.6 million eligible beneficiaries with an acute care hospitalization, 101,507 (1.5%) underwent IHT. Selected characteristics associated with greater adjusted odds of transfer included: patient age 74-85 years (odds ratio [OR], 2.38 compared with 65-74 years; 95% confidence intervals [CI], 2.33-2.43); nonblack race (OR, 1.17; 95% CI, 1.13-1.20); higher comorbidity (OR, 1.37; 95% CI, 1.36-1.37); lower diagnosis-related group-weight (OR, 2.02; 95% CI, 1.95-2.09); fewer recent hospitalizations (OR, 1.87; 95% CI, 1.79-1.95); and hospitalization in the Northeast (OR, 1.40; 95% CI, 1.27-1.55). Higher case mix index of the hospital was associated with a lower adjusted odds of transfer (OR, 0.36; 95% CI, 0.30-0.45). Variability in hospital transfer rates remained significant after adjustment for patient and hospital characteristics (variance 0.28, P = 0.01).ConclusionsIn this nationally representative evaluation, we found that a sizable number of patients undergo IHT. We identified both expected and unexpected patient and hospital-level predictors of IHT, as well as unexplained variability in hospital transfer rates, suggesting lack of standardization of this complex care transition. Our study highlights further investigative avenues to help guide best practices in IHT. Journal of Hospital Medicine 2017;12:435-442.© 2017 Society of Hospital Medicine

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