An analysis of state-reported hospital transfer data of urology patients

Background We examined the trends over time of urology patient transfers in rural and urban settings, at the state level, to better characterize transfer trends in the United States. Materials and methods Data were collected from the State Inpatient Database and Emergency Department Database produced by the Healthcare Cost and Utilization Project. We reviewed the data of all the patients who had been transferred 1 or more times between 2014 and 2016. The data reviewed were from all nonfederal, short-term general hospitals in the states of Arkansas, Florida, Iowa, Nebraska, and New York. The transfers were categorized into emergency department (ED)–to–ED transfers, inpatient-to-inpatient transfers, and ED-to-inpatient transfers at the different facilities. Results Overall, 3.33% (17,519/526,126) of all patient transfers were specific to urology. The mean age of the transferred patients specific to urology was 64.7 years, with 55% of these patients being females. Most of the transferred patients resided in nonmetropolitan or small-metropolitan areas (79.2%). Many transfers occurred at night (43.4%) and during weekends (27.3%). In 2014, the more rural states of Arkansas, Iowa, and Nebraska had higher transfer rates (>35 transfers per 100,000 inhabitants) compared with the more urban states of Florida and New York (both <10 transfers per 100,000). Medicare was significantly more likely to be the payer in the rural states (66%–82%) than in the more populated states (52%–58%). Conclusions We found significant differences in hospital transfer patterns between rural and highly populated states. Understanding these key differences may help in the optimization of hospital transfers, potentially lowering costs, improving patient outcomes, and enhancing patient experience of care.