Impact of institution of a stroke program upon referral bias at a rural academic medical center

Context: Referral bias reflecting the preferential hospital transfer of patients with intracerebral hemorrhage (ICH) has been demonstrated as the major contributing factor for an observed high nonrisk-adjusted in-hospital crude acute stroke mortality rate at a rural academic medical center. Purpose:...

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Bibliographic Details
Published in:The Journal of rural health 2005-06, Vol.21 (3), p.269-271
Main Authors: Riggs, J.E, Libell, D.P, Brooks, C.E, Hobbs, G.R
Format: Article
Language:English
Subjects:
Academic Medical Centers - standards
Academic Medical Centers - utilization
Cerebral Hemorrhage - classification
Cerebral Hemorrhage - mortality
Cerebral Hemorrhage - therapy
Diagnosis-Related Groups
Hospital Mortality
Hospitals, Rural - standards
Hospitals, Rural - utilization
Humans
intracerebral hemorrhage (ICH)
Medical Education
mortality
Mortality Rate
Odds Ratio
Patient Transfer - statistics & numerical data
Patients
Program Effectiveness
Program Evaluation
Referral
Referral and Consultation - statistics & numerical data
Risk Assessment
rural health
rural hospitals
Selection Bias
Severity of Illness Index
stroke
Stroke - classification
Stroke - mortality
Stroke - therapy
West Virginia - epidemiology
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Summary:Context: Referral bias reflecting the preferential hospital transfer of patients with intracerebral hemorrhage (ICH) has been demonstrated as the major contributing factor for an observed high nonrisk-adjusted in-hospital crude acute stroke mortality rate at a rural academic medical center. Purpose: This study was done to assess the impact of a clinical acute stroke program upon referral bias in August 2000. Methods: A chart review of acute stroke (DRG 14) discharges during 2001 from a rural academic medical center was compared with the same data from 1999. Results: The odds ratio of ICH in hospital-transfer patients compared with nonhospital-transfer patients decreased from 11.7 in 1999 to 3.2 in 2001 (P
ISSN:0890-765X
1748-0361
DOI:10.1111/j.1748-0361.2005.tb00094.x