Comparing the hospitalizations of transfer and non-transfer patients in an academic medical center

摘要: BACKGROUND By accepting and caring for patients transferred from other institutions, academic medical centers have been able to develop comprehensive training research programs. Whether institutions can continue do this in the future is questionable. To extent that transfer are more complex severely ill than non-transfer patients, they likely consume resources, managed care payment systems, could place hospitals financial jeopardy. METHOD Between July 1989 December 1993, internal medicine, surgery, pediatrics services of 880-bed University Hospital Michigan accepted 8,740 hospitals. The hospitalizations these were compared with those 76,047 on services. statistical methods used Student's t-test, chi-square, Cochran-Mantel-Haenszel analysis variance. RESULTS resource-use intensive. (p<.0000) be length-of-stay outliers as defined by Medicare standards (28% vs 10%) suffer in-hospital death (9.4% 2.5%). After case-mix adjustment exclusion outliers, three (surgery, pediatrics) remained hospital 1.62, 1.15, 0.84 days longer (p<.0001) patients. Ancillary-service resource use was assessed using a relative-value-unit (RVU) scale based direct-cost dollars. patients' case-mix-adjusted exceeded 1,155,850 957 RVUs pediatrics, medicine (p<.0001). Although Medicaid insurance, differences lengths stay ancillary persisted throughout all insurance groups. Indeed, status, age, sex, best predictor high use. CONCLUSION stayed consumed resources did Age, case-mix, status not account differences. limit liability pose, forced abandon their traditional role such consequences possibility should explored.