Modeling the Factors That Drive the Need for Inter-Facility Transfers to Downstream Services in US Emergency Departments

Improving emergency department (ED) care coordination requires analytics-based models that can integrate large patient-level and hospital databases to help formulate better transfer processes and policies across different hospital settings. This study develops a new empirical model to analyze over one million heart attack emergency department (ED) encounters between 2006-2014 to understand the factors that drive the need for inter-facility transfers (IFT) in different hospital settings. The resulting model has proven helpful for deriving public policy insights from this information. For instance, while we find that while healthcare IFT inequities and inconsistencies persist with ED discharge decisions because of some specific patient and hospital resource factors, these have been reduced significantly in the more recent post-reform period. We conclude by discussing the implications of using this empirical modeling approach for developing smarter policies and procedures for managing and benchmarking downstream healthcare operations practices in this disease area.