Early Treatment at a Referral Center Improves Outcomes for Patients with Acute Vascular Disease

Donald G. Harris, Sarah B. Olson, Claire B. Rosen, Richa Kalsi, Bradley S. Taylor, Jose J. Diaz, Tanya Flohr, Robert S. Crawford

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background: Patients with acute vascular disease frequently need specialized management that may require transfer to a vascular referral center. Although transfer may be medically necessary, it can delay definitive care and is an indicator of incorrect triage to the initial hospital. Regionalization of acute vascular care could improve patient triage and subsequent outcomes. To evaluate the potential benefit from regionalization, we analyzed outcomes of patients treated for acute vascular disease at vascular referral centers. Methods: Using a statewide database capturing all inpatient admissions in Maryland during 2013–2015, patients undergoing noncardiac vascular procedures on an acute basis were identified. Patients admitted to a vascular referral center were stratified by admission status as direct or transfer. The primary outcome was inpatient mortality, and the secondary outcome was resource use. Patient groups were compared by univariable analyses, and the effect of admission status on mortality was assessed by multivariable logistic regression. Results: Of 4,873 patients with acute vascular disease managed at vascular referral centers, 2,713 (56%) were admitted directly, whereas 2,160 (44%) were transferred. Transfers to referral centers accounted for 71% of all interhospital transfers. The transfer-group patients were older, had more comorbidities, and higher illness severities. Patients who were transferred had higher mortality (14% vs. 9%, P < 0.0001), longer hospital lengths of stay, greater critical care–resource utilization, and higher costs. After adjusting for demographics, comorbidities, and illness severity, transfer status was independently associated with higher inpatient mortality. Conclusions: Primary treatment at a referral center is independently associated with improved outcomes for patients with acute vascular disease. Direct admission or earlier triage to a specialty center may improve patient and system outcomes and could be facilitated by standardization and regionalization of complex acute vascular care.

Original languageEnglish (US)
Pages (from-to)52-59
Number of pages8
JournalAnnals of Vascular Surgery
Volume50
DOIs
StatePublished - Jul 1 2018

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Acute Disease
Vascular Diseases
Referral and Consultation
Blood Vessels
Triage
Therapeutics
Inpatients
Mortality
Comorbidity
Length of Stay
Patient Transfer
Logistic Models
Demography
Databases
Costs and Cost Analysis

All Science Journal Classification (ASJC) codes

  • Surgery
  • Cardiology and Cardiovascular Medicine

Cite this

Harris, D. G., Olson, S. B., Rosen, C. B., Kalsi, R., Taylor, B. S., Diaz, J. J., ... Crawford, R. S. (2018). Early Treatment at a Referral Center Improves Outcomes for Patients with Acute Vascular Disease. Annals of Vascular Surgery, 50, 52-59. https://doi.org/10.1016/j.avsg.2018.01.088
Harris, Donald G. ; Olson, Sarah B. ; Rosen, Claire B. ; Kalsi, Richa ; Taylor, Bradley S. ; Diaz, Jose J. ; Flohr, Tanya ; Crawford, Robert S. / Early Treatment at a Referral Center Improves Outcomes for Patients with Acute Vascular Disease. In: Annals of Vascular Surgery. 2018 ; Vol. 50. pp. 52-59.
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abstract = "Background: Patients with acute vascular disease frequently need specialized management that may require transfer to a vascular referral center. Although transfer may be medically necessary, it can delay definitive care and is an indicator of incorrect triage to the initial hospital. Regionalization of acute vascular care could improve patient triage and subsequent outcomes. To evaluate the potential benefit from regionalization, we analyzed outcomes of patients treated for acute vascular disease at vascular referral centers. Methods: Using a statewide database capturing all inpatient admissions in Maryland during 2013–2015, patients undergoing noncardiac vascular procedures on an acute basis were identified. Patients admitted to a vascular referral center were stratified by admission status as direct or transfer. The primary outcome was inpatient mortality, and the secondary outcome was resource use. Patient groups were compared by univariable analyses, and the effect of admission status on mortality was assessed by multivariable logistic regression. Results: Of 4,873 patients with acute vascular disease managed at vascular referral centers, 2,713 (56{\%}) were admitted directly, whereas 2,160 (44{\%}) were transferred. Transfers to referral centers accounted for 71{\%} of all interhospital transfers. The transfer-group patients were older, had more comorbidities, and higher illness severities. Patients who were transferred had higher mortality (14{\%} vs. 9{\%}, P < 0.0001), longer hospital lengths of stay, greater critical care–resource utilization, and higher costs. After adjusting for demographics, comorbidities, and illness severity, transfer status was independently associated with higher inpatient mortality. Conclusions: Primary treatment at a referral center is independently associated with improved outcomes for patients with acute vascular disease. Direct admission or earlier triage to a specialty center may improve patient and system outcomes and could be facilitated by standardization and regionalization of complex acute vascular care.",
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Early Treatment at a Referral Center Improves Outcomes for Patients with Acute Vascular Disease. / Harris, Donald G.; Olson, Sarah B.; Rosen, Claire B.; Kalsi, Richa; Taylor, Bradley S.; Diaz, Jose J.; Flohr, Tanya; Crawford, Robert S.

In: Annals of Vascular Surgery, Vol. 50, 01.07.2018, p. 52-59.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Early Treatment at a Referral Center Improves Outcomes for Patients with Acute Vascular Disease

AU - Harris, Donald G.

AU - Olson, Sarah B.

AU - Rosen, Claire B.

AU - Kalsi, Richa

AU - Taylor, Bradley S.

AU - Diaz, Jose J.

AU - Flohr, Tanya

AU - Crawford, Robert S.

PY - 2018/7/1

Y1 - 2018/7/1

N2 - Background: Patients with acute vascular disease frequently need specialized management that may require transfer to a vascular referral center. Although transfer may be medically necessary, it can delay definitive care and is an indicator of incorrect triage to the initial hospital. Regionalization of acute vascular care could improve patient triage and subsequent outcomes. To evaluate the potential benefit from regionalization, we analyzed outcomes of patients treated for acute vascular disease at vascular referral centers. Methods: Using a statewide database capturing all inpatient admissions in Maryland during 2013–2015, patients undergoing noncardiac vascular procedures on an acute basis were identified. Patients admitted to a vascular referral center were stratified by admission status as direct or transfer. The primary outcome was inpatient mortality, and the secondary outcome was resource use. Patient groups were compared by univariable analyses, and the effect of admission status on mortality was assessed by multivariable logistic regression. Results: Of 4,873 patients with acute vascular disease managed at vascular referral centers, 2,713 (56%) were admitted directly, whereas 2,160 (44%) were transferred. Transfers to referral centers accounted for 71% of all interhospital transfers. The transfer-group patients were older, had more comorbidities, and higher illness severities. Patients who were transferred had higher mortality (14% vs. 9%, P < 0.0001), longer hospital lengths of stay, greater critical care–resource utilization, and higher costs. After adjusting for demographics, comorbidities, and illness severity, transfer status was independently associated with higher inpatient mortality. Conclusions: Primary treatment at a referral center is independently associated with improved outcomes for patients with acute vascular disease. Direct admission or earlier triage to a specialty center may improve patient and system outcomes and could be facilitated by standardization and regionalization of complex acute vascular care.

AB - Background: Patients with acute vascular disease frequently need specialized management that may require transfer to a vascular referral center. Although transfer may be medically necessary, it can delay definitive care and is an indicator of incorrect triage to the initial hospital. Regionalization of acute vascular care could improve patient triage and subsequent outcomes. To evaluate the potential benefit from regionalization, we analyzed outcomes of patients treated for acute vascular disease at vascular referral centers. Methods: Using a statewide database capturing all inpatient admissions in Maryland during 2013–2015, patients undergoing noncardiac vascular procedures on an acute basis were identified. Patients admitted to a vascular referral center were stratified by admission status as direct or transfer. The primary outcome was inpatient mortality, and the secondary outcome was resource use. Patient groups were compared by univariable analyses, and the effect of admission status on mortality was assessed by multivariable logistic regression. Results: Of 4,873 patients with acute vascular disease managed at vascular referral centers, 2,713 (56%) were admitted directly, whereas 2,160 (44%) were transferred. Transfers to referral centers accounted for 71% of all interhospital transfers. The transfer-group patients were older, had more comorbidities, and higher illness severities. Patients who were transferred had higher mortality (14% vs. 9%, P < 0.0001), longer hospital lengths of stay, greater critical care–resource utilization, and higher costs. After adjusting for demographics, comorbidities, and illness severity, transfer status was independently associated with higher inpatient mortality. Conclusions: Primary treatment at a referral center is independently associated with improved outcomes for patients with acute vascular disease. Direct admission or earlier triage to a specialty center may improve patient and system outcomes and could be facilitated by standardization and regionalization of complex acute vascular care.

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