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Impact of Institution of a Stroke Program Upon Referral Bias at a Rural Academic Medical Center
Author(s) -
Riggs Jack E.,
Libell David P.,
Brooks Claudette E.,
Hobbs Gerald R.
Publication year - 2005
Publication title -
the journal of rural health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.439
H-Index - 57
eISSN - 1748-0361
pISSN - 0890-765X
DOI - 10.1111/j.1748-0361.2005.tb00094.x
Subject(s) - medicine , referral , intracerebral hemorrhage , emergency medicine , stroke (engine) , odds ratio , odds , family medicine , acute stroke , medical emergency , subarachnoid hemorrhage , emergency department , nursing , mechanical engineering , logistic regression , engineering
Context: Referral bias reflecting the preferential hospital transfer of patients with intracerebral hemorrhage (ICH) has been demonstrated as the major contributing factor for an observed high nonrisk‐adjusted in‐hospital crude acute stroke mortality rate at a rural academic medical center. Purpose: This study was done to assess the impact of a clinical acute stroke program upon referral bias in August 2000. Methods: A chart review of acute stroke (DRG 14) discharges during 2001 from a rural academic medical center was compared with the same data from 1999. Results: The odds ratio of ICH in hospital‐transfer patients compared with nonhospital‐transfer patients decreased from 11.7 in 1999 to 3.2 in 2001 (P<.035). Conclusions: This study demonstrated the rapid magnitude and significance that clinical programs can have upon referral bias. Changes in referral bias may be more rapid at rural academic medical centers because of the relative lack of health care delivery competition.