# Identification and Prevention of Potentially Inappropriate Inter-hospital Transfers

> **NIH AHRQ R01** · BRIGHAM AND WOMEN'S HOSPITAL · 2022 · $400,000

## Abstract

ABSTRACT
 Despite assumptions that inter-hospital transfer (IHT, the transfer of patients between acute care
hospitals) is done to provide patients with necessary specialized care, IHT also exposes vulnerable
hospitalized patients to the risks of discontinuity of care. Our recent research suggests that a subset of
transferred patients may experience harm during IHT without clear benefit; however, we currently lack data on
how to identify in which patients harm outweighs benefit of transfer, i.e., experience inappropriate IHT.
 The long-term objective of this research is to rigorously define and evaluate the incidence and patient
safety impact of potentially inappropriate IHT among hospitalized medical patients, identify patients at risk for
inappropriate transfer, and develop an intervention toolkit to reduce potentially inappropriate IHT. To achieve
this, we will work with diverse stakeholders involved in IHT, including patients/families, accepting and admitting
clinicians, transferring clinicians, and hospital leadership to define potentially inappropriate IHT. We will then
determine the incidence and patient safety impact of potentially inappropriate IHT via standardized adjudication
of 1800 hospitalized medical patients from 18 US hospitals that participate in a national research collaborative
(HOMERuN) and contribute data to a benchmarking and purchasing organization (Vizient). Adjudication tools
will be based on those used in similar prior research and will be informed by stakeholder definitions of
potentially inappropriate IHT. We will incorporate rigorous adjudicator training and continuous review to ensure
reliability across sites, adjudicators, and time. We will then use standard modelling techniques to
retrospectively characterize a population(s) of potentially inappropriate patient transfers based on several
patient, transfer process, and system-level factors. This will be followed by advanced machine-learning
methods to prospectively identify patients at risk for potentially inappropriate IHT and validation of the model's
performance. Finally, we will utilize key results from the above analyses and stakeholder input to create a
prototype intervention, refine the prototype based on feedback from participating sites using a mixed methods
approach, and develop a toolkit of best practices to prevent potentially inappropriate IHT (e.g., by replacing it
with a safer alternative) for future dissemination. This research will establish a foundation from which
healthcare systems can achieve excellence in providing patients with the right care, in the right setting.

## Key facts

- **NIH application ID:** 10519488
- **Project number:** 1R01HS028621-01A1
- **Recipient organization:** BRIGHAM AND WOMEN'S HOSPITAL
- **Principal Investigator:** Stephanie Mueller
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** AHRQ
- **Fiscal year:** 2022
- **Award amount:** $400,000
- **Award type:** 1
- **Project period:** 2022-09-30 → 2027-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10519488

## Citation

> US National Institutes of Health, RePORTER application 10519488, Identification and Prevention of Potentially Inappropriate Inter-hospital Transfers (1R01HS028621-01A1). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10519488. Licensed CC0.

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