Person:
Tyler, Patrick

Profile Picture

Email Address

AA Acceptance Date

Birth Date

Research Projects

Organizational Units

Job Title

Last Name

Tyler

First Name

Patrick

Name

Tyler, Patrick

Filters

20182

Settings

Author's Publications: search.filters.isAuthorOfPublication.6bec3a09-2b75-42ac-87e6-3037f9b92d89

Search Results

Now showing 1 - 2 of 2
  • No Thumbnail Available
    Publication
    Outcomes of Ventilated Patients With Sepsis Who Undergo Interhospital Transfer: A Nationwide Linked Analysis
    (Ovid Technologies (Wolters Kluwer Health), 2018-01) Rush, Barret; Tyler, Patrick; Stone, David J.; Geisler, Benjamin; Walley, Keith R.; Celi, Leo Anthony
    Objectives The outcomes of critically ill patients who undergo inter-hospital transfer (IHT) are not well understood. Physicians assume that patients who undergo IHT will receive more advanced care that may translate into decreased morbidity or mortality relative to a similar patient who is not transferred. However, there is little empirical evidence to support this assumption. We examined country-level U.S. data from the Nationwide Readmissions Database to examine whether, in mechanically ventilated (MV) patients with sepsis, IHT is associated with a mortality benefit. Design Retrospective data analysis using complex survey design regression methods with propensity score matching. Setting The Nationwide Readmissions Database contains information about hospital admissions from 22 States, accounting for roughly half of U.S. hospitalizations; the database contains linkage numbers so that admissions and transfers for the same patient can be linked across one year of follow-up. Patients From the 2013 NRD Sample, 14,325,172 hospital admissions were analyzed. There were 61,493 patients with sepsis and on MV. Of these, 1630 (2.7%) patients were transferred during their hospitalization. A propensity-matched cohort of 1630 patients who did not undergo IHT was identified. Interventions None. Measurements and Main Results The exposure of interest was inter-hospital transfer to an acute care facility. The primary outcome was hospital mortality; the secondary outcome was hospital length of stay (LOS). The propensity score included age, gender, insurance coverage, do not resuscitate (DNR) status, use of renal replacement therapy, presence of shock and Elixhauser co-morbidities index. After propensity matching, IHT was not associated with a difference in in-hospital mortality (12.3% IHT vs 12.7% non-IHT, p=0.74). However, IHT was associated with a longer total hospital LOS (12.8 days IQR 7.7–21.6 for IHT vs 9.1 days IQR 5.1–17.0 for non-IHT, p<0.01). Conclusions Patients with sepsis requiring MV who underwent IHT did not have improved outcomes compared to a cohort with matched characteristics who were not transferred. The study raises questions about the risk-benefit profile of IHT as an intervention.
  • Thumbnail Image
    Publication
    Racial and Geographic Disparities in Interhospital ICU Transfers
    (Ovid Technologies (Wolters Kluwer Health), 2018-01) Tyler, Patrick; Stone, David J.; Geisler, Benjamin; McLennan, Stuart; Celi, Leo Anthony; Rush, Barret; tyler, patrick
    Objective—Inter-hospital transfer (IHT), a common intervention, may be subject to healthcare disparities. In mechanically ventilated patients with sepsis, we hypothesize that disparities not disease-related would be found between patients who were and were not transferred. Design—Retrospective cohort study. Setting—Nationwide Inpatient Sample, 2006–2012. Patients—Patients over 18 years of age with a primary diagnosis of sepsis who underwent mechanical ventilation. Interventions—none Measurements and Main Results—We obtained age, gender, length of stay, race, insurance coverage, do not resuscitate status, and Elixhauser co-morbidities. The outcome used was interhospital transfer from a small- or medium-sized hospital to a larger acute care hospital. Of 55,208,382 hospitalizations, 46,406 patients met inclusion criteria. In the multivariate model, patients were less likely to be transferred if the following were present: older age (OR 0.98, 95% CI 0.978–0.982), black race (OR 0.79, 95% CI 0.70–0.89), Hispanic race (OR 0.79, 95% CI 0.69– 0.90), South region hospital (OR 0.79, 0.72–0.88), teaching hospital (OR 0.31, 95% CI 0.28– 0.33), and DNR status (OR 0.19, 95% CI 0.15–0.25). Conclusions—In mechanically ventilated patients with sepsis, we found significant disparities in race and geographic location not explained by medical diagnoses or illness severity.