AI Article Synopsis

  • Current pay-for-performance policies neglect the impact of hospital transfers in emergency care, potentially increasing health disparities.
  • A new conceptual framework, the hospital transfer network equity-quality model (NET-EQUITY), aims to analyze how transfer networks affect population health and equity in emergency situations.
  • The NET-EQUITY framework integrates various research perspectives and highlights that internal and external factors, including regulatory and sociocultural elements, significantly influence the structure of hospital transfer networks and patient outcomes.

Article Abstract

Unlabelled: Policy Points Current pay-for-performance and other payment policies ignore hospital transfers for emergency conditions, which may exacerbate disparities. No conceptual framework currently exists that offers a patient-centered, population-based perspective for the structure of hospital transfer networks. The hospital transfer network equity-quality framework highlights the external and internal factors that determine the structure of hospital transfer networks, including structural inequity and racism.

Context: Emergency care includes two key components: initial stabilization and transfer to a higher level of care. Significant work has focused on ensuring that local facilities can stabilize patients. However, less is understood about transfers for definitive care. To better understand how transfer network structure impacts population health and equity in emergency care, we proposea conceptual framework, the hospital transfer network equity-quality model (NET-EQUITY). NET-EQUITY can help optimize population outcomes, decrease disparities, and enhance planning by supporting a framework for understanding emergency department transfers.

Methods: To develop the NET-EQUITY framework, we synthesized work on health systems and quality of health care (Donabedian, the Institute of Medicine, Ferlie, and Shortell) and the research framework of the National Institute on Minority Health and Health Disparities with legal and empirical research.

Findings: The central thesis of our framework is that the structure of hospital transfer networks influences patient outcomes, as defined by the Institute of Medicine, which includes equity. The structure of hospital transfer networks is shaped by internal and external factors. The four main external factors are the regulatory, economic environment, provider, and sociocultural and physical/built environment. These environments all implicate issues of equity that are important to understand to foster an equitable population-based system of emergency care. The framework highlights external and internal factors that determine the structure of hospital transfer networks, including structural racism and inequity.

Conclusions: The NET-EQUITY framework provides a patient-centered, equity-focused framework for understanding the health of populations and how the structure of hospital transfer networks can influence the quality of care that patients receive.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC10037699PMC
http://dx.doi.org/10.1111/1468-0009.12609DOI Listing

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