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Regional health system growth has negative cost implications for stroke care, research shows

With transfers to larger hospitals comes a high cost burden, making it important for community-based organizations to strike the appropriate balance.

Jeff Lagasse, Associate Editor

Stroke patients are increasingly being transferred out of smaller community and rural hospitals and sent to larger medical centers for care and rehabilitation. And while that's a positive sign for patients who need more advanced treatment, the trend has drawbacks in terms of cost and points to the need to improve the coordination of care between hospitals, new research shows.

Community hospitals are often cautious when it comes to decisions regarding stroke treatment, according to University of Rochester Medical Center researchers. That leads to more patients being transferred to larger hospitals, but those transfers come at a high cost burden, making it important for community-based organizations to strike the appropriate balance.

[Also: Racial disparities, geography influence stroke mortality, study shows]

A national movement toward the formation of large regional health systems has occurred since the passage of the Affordable Care Act and its emphasis on population-based health management. This has created opportunities and benefits for both small and large hospitals and their patients, such as increased access to specialized care, continuity of care across health systems and the ability to treat patients closer to home.

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In the case of stroke, the creation of regional health networks seems to have accelerated the transfer of these patients away from smaller hospitals. Using national databases, researchers examined transfer patterns for stroke and transient ischemic attack, or a TIA mini stroke patients from emergency departments of hospitals that serve rural or underserved populations to larger teaching hospitals and academic medical centers. They found that national transfer rates doubled from 2006 to 2014.

[Also: As rural hospitals close and strokes increase, focus turns to ambulances ]

In instances where patients require more advanced care, such as a thrombectomy or neuro-critical care, these inter-hospital transfers are necessary and important. The report also said that transfer rates vary widely. That indicates some hospitals have developed protocols and strong consultation relationships with specialists in stroke centers that allow them to more effectively evaluate and care for patients in their own emergency rooms.

But in some instances, such as TIA and certain less severe strokes, these transfers do not automatically produce an improvement in care and result in unnecessary costs and inconvenience to patients and their families. 

The authors posit that one of the reasons behind the high transfer rates is a general uneasiness on the part of caregivers in smaller hospitals to treat stroke patients. The neurological conditions such as stroke represent the largest category of transfers -- two times greater than trauma, the next largest group.