%0 Journal Article
%T The association between clinical integration of care and transfer of veterans with acute coronary syndromes from primary care VHA hospitals
%A Anne E Sales
%A Sandra L Pineros
%A David J Magid
%A Nathan R Every
%A Nancy D Sharp
%A John S Rumsfeld
%J BMC Health Services Research
%D 2005
%I BioMed Central
%R 10.1186/1472-6963-5-2
%X Prospective cohort study. Transfer rates were obtained for all patients with ACS diagnoses admitted to 12 primary VHA hospitals between 1998 and 1999. Binary variables measuring clinical integration were constructed for each primary VHA hospital reflecting: presence of on-site VHA cardiologist; referral coordinator at the associated tertiary VHA hospital; and/or referral coordinator at the primary VHA hospital. We assessed the association between the integration variables and overall transfer from primary to tertiary hospitals, using random effects logistic regression, controlling for clustering at two levels and adjusting for patient characteristics.Three of twelve hospitals had a VHA cardiologist on site, six had a referral coordinator at the tertiary VHA hospital, and four had a referral coordinator at the primary hospital. Presence of a VHA staff cardiologist on site and a referral coordinator at the tertiary VHA hospital decreased the likelihood of any transfer (OR 0.45, 95% CI 0.27¨C0.77, and 0.46, p = 0.002, CI 0.27¨C0.78). Conversely, having a referral coordinator at the primary VHA hospital increased the likelihood of transfer (OR 6.28, CI 2.92¨C13.48).Elements of clinical integration are associated with transfer, an important process in the care of ACS patients. In promoting optimal patient care, clinical integration factors should be considered in addition to patient characteristics.Coronary artery disease is the leading cause of death among Americans [1]. Hospitalization for acute coronary syndromes (ACS), which includes both acute myocardial infarction (AMI) and unstable angina, is common and costly. Many patients admitted with ACS to primary hospitals (i.e. those without on-site cardiology subspecialty services, including cardiac catheterization facilities) are transferred to tertiary hospitals for cardiac catheterization and consideration of coronary revascularization.The coordination and integration between primary and tertiary hospitals has important i
%U http://www.biomedcentral.com/1472-6963/5/2