Distance, Quality, or Relationship? Interhospital Transfer of Heart Attack Patients

Forthcoming in Production and Operations Manangement

36 Pages Posted: 12 Jan 2017 Last revised: 4 Mar 2017

See all articles by Lauren Xiaoyuan Lu

Lauren Xiaoyuan Lu

University of North Carolina Kenan-Flagler Business School

Susan F. Lu

Purdue University - Krannert School of Management

Date Written: February 2017

Abstract

We empirically investigate the pattern of where heart attack patients are transferred between hospitals. Using 2011 Florida State Emergency Department and Inpatient Databases, we demonstrate the relative importance of three key factors in determining transfer destinations: (1) the distance between sending and receiving hospitals, (2) publicly-reported quality measures of receiving hospitals, and (3) the relationship between sending and receiving hospitals as indicated by whether they are affiliated with the same multihospital system. Our conditional logit analysis shows that hospital relationship plays a more dominant role in determining transfer destinations than distance and quality. This result is robust to three alternative specifications of choice sets using distance ranking, radius circles, and Hospital Referral Regions, and also robust to alternative measures of distance and quality. Using 30-day readmission rate to evaluate the health outcome of transferred patients, we find that relationship-based transfers led to worse outcome than distance-based and quality-based transfers. We also find that nonprofit hospitals are more likely to conduct quality-based transfers and less likely to conduct relationship-based transfers than their for-profit counterparts. Our study calls for reevaluating the current practice of relationship-driven routing of heart attack patients—selecting transfer destinations based on quality or distance can potentially decrease hospital readmission rate.

Keywords: hospital operations, patient routing, quality of care, multihospital system, nonprofit

Suggested Citation

Lu, Lauren Xiaoyan and Lu, Susan Feng, Distance, Quality, or Relationship? Interhospital Transfer of Heart Attack Patients (February 2017). Forthcoming in Production and Operations Manangement. Available at SSRN: https://ssrn.com/abstract=2896812 or http://dx.doi.org/10.2139/ssrn.2896812

Lauren Xiaoyan Lu (Contact Author)

University of North Carolina Kenan-Flagler Business School ( email )

McColl Building, CB#3490
Chapel Hill, NC 27599
United States

HOME PAGE: http://public.kenan-flagler.unc.edu/faculty/lul/index.htm

Susan Feng Lu

Purdue University - Krannert School of Management ( email )

1310 Krannert Building
West Lafayette, IN 47907-1310
United States

HOME PAGE: http://https://sites.google.com/site/susanluhome/home

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