Quality Implications of Transferring Emergency Department Patients from Rural Hospitals

Research center:
Lead researcher:
Project funded:
September 2012
Project completed:
February 2014
Statement of the Problem: Rural hospitals provide first-line treatment for emergency patients and play a crucial role in stabilizing patients and coordinating transfers to tertiary care. However, little is known about patients who are transferred directly from rural Emergency Departments to other hospitals or their impact on hospital mortality rates.

Project goals: The purpose of this project is to analyze the quality implications of transferring emergency patients from smaller rural hospitals to larger rural and urban facilities.

Methods: The project will use Medicare inpatient and Emergency Department claims data and descriptive and multivariate statistical methods to: 1) compare patients who are transferred directly from rural hospital Emergency Departments to larger hospitals with those who are admitted as inpatients to rural hospitals in terms of diagnoses, comorbidities, demographics, and the care received and 2) analyze how the inclusion or exclusion of transferred emergency patients affects risk-adjusted mortality rates for transferring and receiving hospitals.

Anticipated publications/products: A policy brief; a peer-reviewed journal manuscript; and presentations at conferences and to key policy audiences such as NQF, the Joint Commission, CMS, State Hospital Associations and State Offices of Rural Health.


  • Rural Emergency Department Staffing and Participation in Emergency Certification and Training Programs
    Journal Article
    University of Minnesota Rural Health Research Center
    Date: 06/2008
    This paper describes how rural hospitals nationally are staffing their emergency departments (EDs) and explores the participation of rural ED physicians and other healthcare professionals in selected certification and training programs that teach skills needed to provide high quality emergency care.
  • Which Medicare Patients Are Transferred From Rural Emergency Departments?
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 06/2014
    A brief from the University of Minnesota Rural Health Research Center analyzes transfers of Medicare beneficiaries who received emergency care in a critical access hospitals or rural hospitals and were transferred to other hospitals for care.