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Post-Op Transfers More Likely at Critical Access Hospitals

In unadjusted analyses, fewer critical access hospital surgical patients receive post-acute care

TUESDAY, May 20, 2014 (HealthDay News) -- Patients with surgical admissions at critical access hospitals (CAHs) more often have hospital transfers, according to a study published online May 14 in JAMA Surgery.

Adam J. Gadzinski, M.D., from the University of Michigan Health System in Ann Arbor, and colleagues analyzed data from the Nationwide Inpatient Sample (2005 to 2009) and the American Hospital Association to examine discharge practice patterns after surgical admissions at CAHs. Participants underwent common surgical procedures at CAHs or non-CAHs.

The researchers found that a greater proportion of patients from CAHs were transferred to another hospital for each of six common inpatient surgical procedures (P < 0.01). However, for all but one procedure examined, the likelihood of receiving post-acute care was lower for patients discharged from CAHs (P < 0.01; except transurethral resection of the prostate: P = 0.76). In analyses adjusted for patient and hospital factors, the likelihood of transfer by CAHs persisted for three procedures: hip replacement (odds ratio [OR], 1.90), colorectal cancer resection (OR, 3.37), and cholecystectomy (OR, 1.67) (P < 0.05 for each); differences in post-acute care did not persist. For Medicare beneficiaries treated in CAHs, discharge with post-acute care was less likely after hip fracture repair and hip replacement (ORs, 0.65 and 0.70, respectively).

"These results will affect the ongoing debate concerning CAH payment policy and its implications for health care delivery in rural communities," the authors write.

One author disclosed financial ties to ArborMatrix and one disclosed ties to Blue Cross Blue Shield of Michigan.

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