{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T22:14:29Z","timestamp":1777673669339,"version":"3.51.4"},"reference-count":32,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2025,7,23]],"date-time":"2025-07-23T00:00:00Z","timestamp":1753228800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2025,7,23]],"date-time":"2025-07-23T00:00:00Z","timestamp":1753228800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Health\ufffdServ\ufffdInsights"],"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Affiliations between community and academic hospitals are increasing. However, their impact on transfer practices remains under-characterized.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives:<\/jats:title>\n                    <jats:p>To understand the impacts of hospital affiliation on transfer practices and hospital resource utilization.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design:<\/jats:title>\n                    <jats:p>Retrospective cohort study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We included patients \u2a7e18\u2009years who were transferred from a 178-bed community hospital to a tertiary academic hospital between January 2015 to December 2019. Interrupted time series analysis was used to evaluate changes in outcomes after the affiliation in January 2017. Our primary outcome was the change in quarterly rate of early discharge (discharge within 48\u2009hours post-transfer). Secondary outcomes included change in quarterly proportions of low-income patients, patients residing at a far distance from the hospital, and ICU admissions. We performed a sub-analysis in patients transferred to a surgical specialty that evaluated the tri-annual rate of operative management (surgical or interventional radiology procedure performed &lt;72\u2009hours after admission).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Among 144 included patients, 93 (64.6%) were transferred post-affiliation and 63 (43.1%) were transferred to a surgical specialty. No significant trends were seen across outcomes in the pre-affiliation period. Relative to the former period, there was a quarterly decrease in early discharge rates (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009=\u2009.027) and a quarterly increase in the percentage of patients residing at a long distance from the transferring hospital (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009=\u2009.027) after affiliation. There was also a relative tri-annual decrease in the rate of operative management (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009=\u2009.039).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Post-affiliation, the volume of transfers and utilization of resources at the receiving hospital increased. The percentage of transfer patients residing farther from the transferring hospital also increased.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/11786329251357378","type":"journal-article","created":{"date-parts":[[2025,7,23]],"date-time":"2025-07-23T09:14:34Z","timestamp":1753262074000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["The Impact of Hospital Affiliation on Hospital Transfer Practices"],"prefix":"10.1177","volume":"18","author":[{"given":"Wardah","family":"Rafaqat","sequence":"first","affiliation":[{"name":"Medical College, Aga Khan University, Karachi, Sindh, Pakistan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6514-1646","authenticated-orcid":false,"given":"Omar","family":"Mahmud","sequence":"additional","affiliation":[{"name":"Medical College, Aga Khan University, Karachi, Sindh, Pakistan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher","family":"Alba","sequence":"additional","affiliation":[{"name":"Harvard Medical School, Boston, MA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"May","family":"Abiad","sequence":"additional","affiliation":[{"name":"Division of Trauma, Emergency General Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emanuele","family":"Lagazzi","sequence":"additional","affiliation":[{"name":"Division of Trauma, Emergency General Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dias","family":"Argandykov","sequence":"additional","affiliation":[{"name":"Division of Trauma, Emergency General Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John O.","family":"Hwabejire","sequence":"additional","affiliation":[{"name":"Division of Trauma, Emergency General Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"George C.","family":"Velmahos","sequence":"additional","affiliation":[{"name":"Division of Trauma, Emergency General Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonathan J.","family":"Parks","sequence":"additional","affiliation":[{"name":"Division of Trauma, Emergency General Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7042-7400","authenticated-orcid":false,"given":"Michael P.","family":"DeWane","sequence":"additional","affiliation":[{"name":"Division of Trauma, Emergency General Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2025,7,23]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.hpb.2018.11.013"},{"key":"e_1_3_3_3_2","unstructured":"Affordable Care. 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