Interhospital transfer among US veterans admitted to community and veterans affairs hospitals for acute myocardial infarction and ischemic stroke before and during the COVID-19 pandemic.

Vaughan-Sarrazin MS, Miell KR, Beck BF, Mecham B, Bailey G, Wardyn S, Mohr N, Ohl M. Interhospital transfer among US veterans admitted to community and veterans affairs hospitals for acute myocardial infarction and ischemic stroke before and during the COVID-19 pandemic. Journal of hospital medicine. 2024 Oct 5.

Dimensions for VA is a web-based tool available to VA staff that enables detailed searches of published research and research projects.

If you have VA-Intranet access, click here for more information vaww.hsrd.research.va.gov/dimensions/

VA staff not currently on the VA network can access Dimensions by registering for an account using their VA email address.    Search Dimensions for VA for this citation
* Don't have VA-internal network access or a VA email address? Try searching the free-to-the-public version of Dimensions

Search for Abstract from PubMed

---

Abstract:

BACKGROUND: Veterans Health Administration (VHA) enrollees may use community hospitals for inpatient care and sometimes require transfer to larger community or VHA hospitals. Little is known about interhospital transfer patterns among veterans using community and VHA hospitals or how coronavirus disease 2019 (COVID-19) case surges affected transfer. METHODS: Retrospective cohort study among veterans age 65+ admitted to community and VHA hospitals for acute myocardial infarction (AMI) or acute ischemic stroke (AIS) during 2018-2021. We examined associations between COVID-19 case density in regional hospital referral networks and the likelihood of transfer. RESULTS: A total of 8373 (23.6%) veterans with AMI and 4630 (13.1%) with AIS were transferred in the prepandemic period. Transfer was especially common for rural veterans (36% with AMI, 20% with AIS). Most transfers (88%) were between community hospitals and 6% from community to VHA. Among AMI patients, transfer was less likely among patients age > 90 (relative to age 65-69), those with non-White race/ethnicity, and females. Transfer was more common among patients initially seen in rural hospitals (AMI, odds ratio [OR]? = 2.73, 95% confidence interval [CI], 2.90-3.74; AIS, OR? = 2.43; 95% CI, 2.24-2.65). During 2020-2021, transfer among AMI patients was less likely during COVID-19 case density surges affecting the admitting hospital''s referral network (OR? = 0.86; 95% CI, 0.78-0.96 for highest compared with lowest quartile of COVID-19 cases). CONCLUSION: Interhospital transfer was common for veterans with AMI and AIS, especially among rural veterans. Few transfers were to VHA hospitals. COVID-19 case surges were associated with decreased transfer for veterans with AMI, potentially limiting access to needed care.