PATIENTS TRANSFERRED TO ACADEMIC MEDICAL-CENTERS AND OTHER HOSPITALS

As purchasers of health care increasingly rely on hospital resource us e and outcomes profiles to guide quality improvement efforts and contr act decisions, a better understanding of the contribution of the most severely ill patients to aggregate resource use and outcomes is needed to develop measures that make fair comparisons between hospitals. In this article, the authors examine the distribution, resource utilizati on, and outcomes of transferred patients (''transfers''), a group know n to be highly complex. The study examines the contributions to resour ce use and outcomes of these patients at academic medical centers (AMC s) and non-teaching hospitals. The authors go beyond previous work by comparing AMCs with non-teaching hospitals, and by using a nationally representative sample for the year 1992. The detailed findings demonst rated that AMCs provided a disproportionate share of care to transfers in 1992, and that transfers to AMCs are more complex and require more specialized care than do transfers to non-teaching hospitals. The stu dy also determined that, during the time studied, AMCs received a disp roportionate share of Medicaid and indigent-care transfers. Finally, t he findings demonstrated that transfers increased in absolute numbers and as a percentage bf total patient volumes for all hospitals from 19 88 to 1994. The rate of increase was greatest for AMCs. The authors ex plain why they believe that their findings are applicable today, altho ugh they caution that study of more recent data should be made. The au thors comment that purchasers of health care may find the study useful in better understanding benchmarking tools used to evaluate hospitals . This study may also help those involved in health policy to more ful ly understand the magnitude of the contribution to transfer patient ca re provided by AMCs. Finally, health policymakers and planners may fin d this work useful as they prepare for increasing numbers of transfers in the future, particularly at AMCs.