Acute Care Hospital Transfers by Major Diagnostic Category (MDC)

In 2021, 13.4 percent of transplant and tracheostomy hospital stays ended in a transfer to a different hospital, higher than any other MDC, and over four times as high as for patients with multiple trauma (4.0 percent).

Why publish Acute Care Hospital Transfers by Major Diagnosis Category (MDC)?#

Typically, a hospitalized patient will have their entire inpatient stay at a single facility, from admission to discharge. But there are times when it is necessary for patients to be transferred from one acute care hospital to another. The decision to transfer a patient considers the benefits of care available at another facility against the potential risks involved in moving. Identifying and evaluating transferred patients is needed to better understand who is being transferred, what post-transfer outcomes they experience, and which facilities are likely to receive them.

Key Findings#

• Expected Payer: Patients who get transferred are more likely to have Medicare as their expected payer type.
• Age and assigned sex at birth: Older patients are transferred more often. Likewise, male patients are more likely to be transferred than female patients.
• Preferred Language Spoken: Language appears to have no bearing on the overall percent of transfers; English only, Spanish only and all other languages have comparable overall percent of transfers.
• Race/Ethnicity: Hispanic patients are the least likely to be transferred, per the reported encounters.

Note: Each visualization focuses on a different intersection between a characteristic of the patient or encounter and transfers. Patient groupings were created based on assigned sex at birth, race/ethnicity, expected payer type, preferred language spoken and age category.

Outcomes by Major Diagnosis Category#

Key Findings#

• Length of stay and inpatient deaths: Transferred patients with PRE-MDC’s such as transplants and tracheostomies have the longest length of stay (29 days) and greatest rates of inpatient deaths (20 percent) at the receiving facility.
• Leaving Against Medical Advice (AMA): Transferred patients with Alcohol/Drug Use & Alcohol/Drug Induced Organic Mental Disorders have the greatest rate of leaving AMA. (12 percent).

How HCAI Created This Product#

The Acute Care Hospital Transfers by Major Diagnostic Category (MDC) were identified from the number of transfers for each MDC reported in the Patient Discharge Data (PDD) in 2021. To protect patient personal information, the California Health and Human Services Agency has adopted a policy of statistically masking or de-identifying sensitive data (CalHHS Data De-identification guidelines). Transfers were identified by linking PDD encounters based on discharge date, admission date, Social Security Number and Date of Birth. To assure that patient identity is protected, any MDC per hospital grouping with less than 11 encounters have a ‘Less than 11’ label (473 encounters). The list of MDCs can be found in the 2021 Complete Data Documentation  (ZIP file) on HCAI’s Data Documentation page. 

Medicare includes: Medicare Advantage, traditional Medicare. Medi-Cal includes: Medi-Cal managed care, fee-for-service Medi-Cal. Private Coverage includes: employer group coverage, individual coverage (including coverage purchased through Covered California), organized charity payers (e.g., March of Dimes, Shriners). Uninsured includes: uninsured patients, as well as instances when insurance does not cover the treatment, or the patient would like to keep the medical procedure private. Other Payer includes: Workers’ Compensation, County Indigent Programs, any third-party payment not included in any other category, stays for which no payment will be required by the facility (e.g. courtesy patients), and stays for which no valid expected payer was reported to HCAI.

Additional Information#

Topic: Healthcare Utilization
Source Link: Healthcare Utilization – Inpatient Discharges
Citation: HCAI – Patient Discharge Data – Acute Care Hospital Transfers by Major Diagnostic Category (MDC)
Temporal Coverage: 2021
Spatial/Geographic Coverage: Statewide, County
Frequency: Annually