Interfacility transfer for urgent care is a core component of organized stroke systems. The study aimed to characterize the population emergently transferred for ischemic stroke care in the United States from 2016 through 2022, using claims data to inform transfer system optimization.
This was a nationwide longitudinal cross-sectional analysis of Medicare fee-for-service (FFS) claims. The cohort included beneficiaries aged 65 years or older admitted with ischemic stroke between 2016 and 2022. The authors used county-level Medicare Advantage penetration rates to extrapolate FFS results to estimated nationwide emergent transfers.
To identify features distinguishing transferred from nontransferred patients, the investigators applied multilevel logistic regression models. The analysis compared demographic characteristics, treatment received (including thrombectomy and thrombolysis), and features of the presenting facility such as rural location, bed count, critical access hospital status, teaching status, stroke center designation, and vertical integration.
Across the 2016–2022 study period, 824,551 Medicare FFS beneficiaries were admitted with ischemic stroke. Of these, 99,751 patients (12%) underwent emergent interfacility transfer and 724,800 patients (88%) were not transferred.
Demographics and treatment differences
Presenting facility characteristics
Estimated nationwide trends
Multilevel logistic regression identified facility, clinical, and demographic features associated with the odds of emergent transfer.
Factors associated with higher odds of transfer
Factors associated with lower odds of transfer
Using Medicare FFS claims, the investigators describe a large cohort of older adults admitted with ischemic stroke and identify the subgroup undergoing emergent interfacility transfer. Key findings include the higher likelihood of reperfusion therapies (thrombectomy and thrombolysis) among transferred patients and the concentration of transfers originating from small, rural, or critical access hospitals and from non–stroke center facilities.
Temporal trends estimated from the data show an increase in emergent transfers through 2019 followed by a decline through 2022, reversing a prior upward trend in transfers. The abstract does not provide detailed explanations for the post-2019 decline or specific policy, practice, or resource changes that may have contributed to these temporal patterns; such details were not reported in the source abstract.
The multilevel modeling highlights structural and clinical drivers of transfer: smaller hospitals and critical access status were strong predictors of transfer, whereas larger hospitals, stroke centers, older patient age, and higher area affluence were associated with lower transfer probability. The study used county-level Medicare Advantage penetration to extrapolate FFS findings to nationwide estimates; the abstract does not present the full extrapolation methods, sensitivity analyses, or limitations beyond what is summarized here.
Overall, the study's reported data underscore the ongoing role of transfers in delivering access to reperfusion therapies and point to persistent geographic and structural disparities in where patients first present. The abstract indicates that understanding this transfer population can inform optimization of stroke transfer systems, but it does not detail specific recommendations or operational strategies.