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{
    "pk": 12460,
    "title": "Potentially Avoidable Transfers of Veterans with Mental Health Conditions in the Veterans Health Administration",
    "subtitle": null,
    "abstract": "Objective:\n Over 40% of the 2.4 million emergency department (ED) visits to Veterans Health Administration (VHA) hospitals are from veterans who live in rural areas, a population at increased risk of interfacility transfer. Veterans may undergo interfacility transfer to obtain emergent or urgent access to specialized health services, particularly mental health care. However, such transfers raise questions regarding appropriate use of resources, travel burdens for patients and families, and logistical challenges for ED staff and providers that may delay timely care. We sought to describe ED-based, interfacility transfer rates within the VHA and to estimate the proportion of potentially avoidable transfers (PAT) of patients with mental health conditions relative to other diseases.\nMethods\n: This observational cohort included all patients who were transferred from a VHA ED to another VHA hospital between 2012 and 2014. We extracted data from Clinical Data Warehouse administrative data. PAT was defined as discharge from the receiving ED without a procedure, or hospital length of stay at the receiving hospital ≤ 1 day without having a procedure performed. We conducted facility-level and diagnosis-level analysis to identify conditions for which an alternative to transfer, such as telehealth access to specialty care, could be developed and implemented in low-volume or rural EDs.\nResults:\n Of 6,131,734 ED visits during the three-year study period, 18,875 (0.3%) were transferred from one VHA ED to another VHA facility. Rural residents were transferred three times as often as urban residents (0.6% vs. 0.2%, p<0.001), and 23.6% of all VHA-to-VHA transfers met the PAT definition. Mental health conditions were the most common reason for interfacility transfer (34% of all interfacility transfers), followed by heart disease (12%). Of transfers that met PAT criteria, 11% were for mental health diagnoses whereas 21% were for heart disease. Geographic analysis suggested that overall PAT proportion ranged across regions from 8-53% with mental health PATs between 2-42%. \nConclusion:\n VHA interfacility transfer is commonly performed for mental health diagnoses, and there is substantial regional variation in potentially avoidable transfers in a national sample of transfers. A significant proportion of these transfers may be potentially avoidable. Future work should focus on improving capabilities to provide specialty evaluation locally for these conditions, possibly using telehealth solutions. Additional work should also focus on measuring the timeliness of these transfers.",
    "language": "en",
    "license": {
        "name": "Creative Commons Attribution 4.0",
        "short_name": "CC BY 4.0",
        "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.",
        "url": "https://creativecommons.org/licenses/by/4.0"
    },
    "keywords": [],
    "section": "Abstracts",
    "is_remote": true,
    "remote_url": "https://escholarship.org/uc/item/7zs493xc",
    "frozenauthors": [
        {
            "first_name": "Nicholas",
            "middle_name": "M.",
            "last_name": "Mohr",
            "name_suffix": "",
            "institution": "Center for Comprehensive Access Delivery Research & Evaluation (CADRE), VA Iowa City Healthcare System, Department of Emergency Medicine and Anesthesia, Iowa City, Iowa",
            "department": "None"
        },
        {
            "first_name": "Chaorong",
            "middle_name": "",
            "last_name": "Wu",
            "name_suffix": "",
            "institution": "1Center for Comprehensive Access Delivery Research & Evaluation (CADRE), VA Iowa City Healthcare System, Iowa City, Iowa\n\nUniversity of Iowa, Institute for Clinical and Translational Sciences, Iowa City, Iowa",
            "department": "None"
        },
        {
            "first_name": "Michael",
            "middle_name": "J.",
            "last_name": "Ward",
            "name_suffix": "",
            "institution": "Tennessee Valley Healthcare System VA Medical Center, Nashville, Tennessee\n\nVanderbilt University Medical Center, Department of Emergency Medicine, Nashville, Tennessee",
            "department": "None"
        },
        {
            "first_name": "Candace",
            "middle_name": "D.",
            "last_name": "McNaughton",
            "name_suffix": "",
            "institution": "Tennessee Valley Healthcare System VA Medical Center, Nashville, Tennessee\n\nVanderbilt University Medical Center, Department of Emergency Medicine, Nashville, Tennessee",
            "department": "None"
        },
        {
            "first_name": "Peter",
            "middle_name": "J.",
            "last_name": "Kaboli",
            "name_suffix": "",
            "institution": "Center for Comprehensive Access Delivery Research & Evaluation (CADRE), VA Iowa City Healthcare System, Iowa City, Iowa\n\nUniversity of Iowa Carver College of Medicine, Department of Internal Medicine, Iowa City, Iowa",
            "department": "None"
        }
    ],
    "date_submitted": "2019-01-23T20:52:51Z",
    "date_accepted": "2019-01-23T20:52:51Z",
    "date_published": "2019-02-28T20:57:31Z",
    "render_galley": null,
    "galleys": [
        {
            "label": "",
            "type": "pdf",
            "path": "https://journalpub.escholarship.org/westjem/article/12460/galley/6616/download/"
        }
    ]
}