Exploring interhospital transfers and partnerships in the hospital sector in New South Wales, Australia
Hassan Assareh A E , Helen M. Achat A , Jean-Frederic Levesque B C and Stephen R. Leeder DA Epidemiology and Health Analytics, Western Sydney Local Health District, Sydney, NSW 2151, Australia. Email: helen.achat@health.nsw.gov.au
B Centre for Primary Health Care and Equity, UNSW, Sydney, NSW 2052, Australia. Email: JeanFrederic.Levesque@health.nsw.gov.au
C Bureau of Health Information, Sydney, NSW 2067, Australia.
D Menzies Centre for Health Policy, University of Sydney, Sydney, NSW 2006, Australia. Email: stephen.leeder@sydney.edu.au
E Corresponding author. Email: Hassan.Assareh@health.nsw.gov.au
Australian Health Review 41(6) 672-679 https://doi.org/10.1071/AH16117
Submitted: 30 May 2016 Accepted: 28 September 2016 Published: 4 November 2016
Abstract
Objective The aim of the present study was to explore characteristics of interhospital transfers (IHT) and sharing of care among hospitals in New South Wales (NSW), Australia.
Methods Data were extracted from patient-level linked hospital administrative datasets for separations from all NSW acute care hospitals from 1 July 2013 to 30 June 2015. Patient discharge and arrival information was used to identify IHTs. Characteristics of patients and related hospitals were then analysed.
Results Transfer-in patients accounted for 3.9% of all NSW admitted patients and, overall, 7.3% of NSW admissions were associated with transfers (IHT rate). Patients with injuries and circulatory system diseases had the highest IHT rate, accounting for one-third of all IHTs. Patients were more often transferred to larger than smaller hospitals (61% vs 29%). Compared with private hospitals, public hospitals had a higher IHT rate (8.4% vs 5.1%) and a greater proportion of transfer-out IHTs (52% vs 28%). Larger public hospitals had lower IHT rates (3–8%) compared with smaller public hospitals (13–26%). Larger public hospitals received and retransferred higher proportions of IHT patients (52–58% and 11% respectively) than their smaller counterparts (26–30% and 2–3% respectively). Less than one-quarter of IHTs were between the public and private sectors or between government health regions. The number of interacting hospitals and their interactions varied across hospital peer groups.
Conclusion NSW IHTs were often to hospitals with greater speciality services. The patterns of interhospital interactions could be affected by organisational and regional preferences.
What is known about the topic? IHTs aim to provide efficient and effective care. Nonetheless, information on transfers and the sharing of care among hospitals in an Australian setting is lacking. Studies of transfers and hospital partnership patterns will inform efforts to improve patient-centred transfers and hospital accountability in terms of end outcomes for patients.
What does this paper add? Transfer-in patients accounted for 3.9% of all NSW admissions; they were often (61%) transferred to hospitals with greater speciality services. The number of IHTs and sharing of care among hospitals varied across hospital peer groups, and could have been affected by organisational and regional preferences.
What are the implications for practitioners? The findings of the present study suggest that different patterns of IHTs may not only have resulted from clinical priorities, but that organisational and regional preferences are also likely to be influential factors. Patient-centred IHTs and the development of guidelines need to be pursued to enhance the care and functionality of healthcare. Patient sharing should be acknowledged in hospital and regional performance profiling.
Additional keywords: benchmarking, partnership network, patient outcome.
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