Discordance Between Patient and Clinician Experiences and Priorities in Rural Interhospital Transfer: A Mixed Methods Study

Nicholas M Mohr; Terrence S Wong; Brett Faine; Adam Schlichting; Joseph Noack; Azeemuddin Ahmed

doi:10.1111/jrh.12125

Discordance Between Patient and Clinician Experiences and Priorities in Rural Interhospital Transfer: A Mixed Methods Study

J Rural Health. 2016 Winter;32(1):25-34. doi: 10.1111/jrh.12125. Epub 2015 Jul 14.

Authors

Nicholas M Mohr^{1

2}, Terrence S Wong¹, Brett Faine³, Adam Schlichting^{1

4}, Joseph Noack¹, Azeemuddin Ahmed¹

Affiliations

¹ Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa.
² Division of Critical Care, Department of Anesthesia, University of Iowa Carver College of Medicine, Iowa City, Iowa.
³ Department of Pharmaceutical Care, University of Iowa Hospitals and Clinics, Iowa City, Iowa.
⁴ Division of Pulmonary, Critical Care, and Occupational Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa.

PMID: 26174410
DOI: 10.1111/jrh.12125

Abstract

Purpose: Rural emergency department (ED) patients require interhospital transfer for definitive care at nearly 6 times the national rate, yet transfer decision-making is variable. The goal of this study was to understand patient experiences, preferences, and decision-making in the rural interhospital transfer process, and to measure the concordance between patient opinions and provider perceptions.

Methods: Ours is a mixed methods study of patients transferred to a 711-bed Midwestern academic medical center and the emergency physicians in community hospitals. Qualitative interviews were conducted by a single research assistant with admitted patients transferred from an ED, and a corresponding survey was distributed to community emergency physicians. Standardized scenarios were posed to both groups to understand transfer priorities.

Findings: Seventy-nine patients and 40 physicians participated in this study. Patients and physicians cited proximity to home, medical expertise, a personal relationship with a health care provider, health insurance, privacy concerns, and patient choice as the primary factors that influenced patient transfer priorities. Compared with patient respondents, physicians overestimated the patient-perceived importance of proximity to home (P = .015) and being cared for by a personal physician (P = .049), but they underestimated the value of receiving treatment in a comprehensive medical center (P = .002). In standardized scenarios, physicians agreed with patients in transfer preferences for conditions requiring neurosurgical consultation, but they underestimated patients' desire for transfer for pneumonia requiring mechanical ventilation.

Conclusion: Patients and physicians recognize similar factors that influence patient preferences in interhospital ED transfer, but physicians may overestimate the value of nonmedical influences on decision-making priorities.

Keywords: access to care; hospitals; medical care; satisfaction with care; utilization of health services.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Attitude of Health Personnel*
Female
Health Services Research
Humans
Male
Outcome Assessment, Health Care
Patient Participation / statistics & numerical data*
Patient Satisfaction / statistics & numerical data*
Patient Transfer / statistics & numerical data*
Referral and Consultation / statistics & numerical data*
Urban Population / statistics & numerical data*