Differentiating Interhospital Transfer Types: Varied Impacts and Diverging Coordination Strategies

Interhospital transfer (IHT) is common in care delivery. As a form of care transition, IHT faces coordination challenges and can negatively affect care outcomes. Understanding the underlying reasons and the associated operational challenges of different IHT types can help hospital managers design mitigation mechanisms to improve the IHT care outcomes. We conceptually and empirically differentiate between clinical and non-clinical transfers based on their unique characteristics and compare their respective impacts on care outcomes, including length of stay (LOS), readmission, and mortality. Non-clinical transfers are found to have worse care outcomes than clinical transfers and largely accounts for the inferior care outcomes of IHT compared with direct admissions, perhaps due to inadequate care coordination. Since poor coordination between hospitals is frequently cited as a root cause of care quality problems, we investigate whether two coordination mechanisms, namely hospital system affiliation and transfer routinization, can mitigate the potential negative effects of IHT on care outcomes. Our analyses suggest that the two coordination mechanisms are associated with improved IHT outcomes, and both seem to have stronger effects for non-clinical transfers. Specifically, system affiliation and transfer routinization can reduce LOS and readmission for non-clinical transfers. The results offer valuable insights to hospital managers for improving IHT care outcomes.