(256) Impact of State Transfer Coordination Centers on Interhospital Transfer Rates During Pandemic Surges

Tuesday, February 25, 2025

12:30pm – 1:30pm Eastern Time

Location: Connections Central - RST 02

First Author(s)

MR

Mary E. Richert, MD (she/her/hers)

National Institutes of Health Clinical Center
National Institutes of Health
Bethesda, Maryland, United States

Co-Author(s)

GD

Guoqing Diao, MS, PhD

Professor
Dept of Biostatistics, George Washington University, Washington, DC; Critical Care Medicine Department, NIH Clinical Center, Bethesda, MD; Critical Care Medicine Branch, National Heart, Lung and Blood Institute, Bethesda, MD, United States
AM

Alex Mancera, MS

Data Scientist
Critical Care Medicine Department, NIH Clinical Center, Bethesda, MD; Critical Care Medicine Branch, National Heart, Lung and Blood Institute, Bethesda, MD, United States
MN

Maniraj Neupane, MD, PhD

Critical Care Medicine Physician
Critical Care Medicine Department, NIH Clinical Center, Bethesda, MD; Critical Care Medicine Branch, National Heart, Lung and Blood Institute, Bethesda, MD, United States
RA

Roxana Amirahmadi, MD

Critical Care Medicine Fellow
Critical Care Medicine Department, NIH Clinical Center, Bethesda, MD; Critical Care Medicine Branch, National Heart, Lung and Blood Institute, Bethesda, MD, United States
SS

Sadia Sarzynski, MD, MHS

Staff Clinician
Critical Care Medicine Department, NIH Clinical Center, Bethesda, MD; Critical Care Medicine Branch, National Heart, Lung and Blood Institute, Bethesda, MD, United States
SW

Sarah Warner, MPH

Senior Data Manager
Critical Care Medicine Department, NIH Clinical Center, Bethesda, MD; Critical Care Medicine Branch, National Heart, Lung and Blood Institute, Bethesda, MD, United States
JW

Joel Weissman, PhD

Associate Professor of Health Care Policy
Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
EG

Eric Goralnick, MD, MS

Associate Professor of Emergency Medicine
Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
BF

Brian J. Franklin, MD, MBA

Emergency Medicine Resident
Dept of Emergency Medicine, Stanford University, Palo Alto, CA, United States
BS

Bruce Swihart, PhD

Statistician
Critical Care Medicine Department, NIH Clinical Center, Bethesda, MD; Critical Care Medicine Branch, National Heart, Lung and Blood Institute, Bethesda, MD, United States
JH

John Hick, MD

Professor of Emergency Medicine
Hennepin County Medical Center, Minneapolis, MN; University of Minnesota Medical School, Minneapolis, MN, United States
SM

Steven Mitchell, MD

Associate Professor of Emergency Medicine
UW Medicine Harborview Medical Center, Seattle, Washington; Dept of Emergency Medicine, University of Washington, Seattle, WA, United States
PK

Parneet Kaur, N/A

Biostatistician
National Emergency Medical Services Information Systems (NEMSIS), Salt Lake City, UT, United States
BF

Benjamin Fisher, MPA, NRP

Research and Emergency Management Services (EMS) Specialist
National Emergency Medical Services Information Systems (NEMSIS), Salt Lake City, UT, United States
Sameer Kadri, MD, MS

National Institutes of Health Clinical Center
Bethesda

Introduction: Pandemic surges curtailed ICU bed capacity and hindered interhospital transfers. Within the United States, state Medical Operations Coordination Centers (MOCCs) were established to facilitate balancing critically ill patients across hospitals. However, MOCCs were only adopted by a subset of states and now risk closure amidst dwindling federal emergency funding. Understanding whether MOCCs were helpful in facilitating transfers during surges is critical to understanding their value for future health emergencies.

Methods: An interrupted time series (ITS) analysis was conducted using negative binomial regression to study the impact of state MOCCs on weekly interfacility transfers (IFT) from agencies within the United States continuously reporting in the National Emergency Medical Services Information Systems database between Jan 1, 2019 and Dec 30, 2022. The establishment of state MOCCs was adjudicated through a published survey and inquiries from health departments. The ITS inflection point was normalized to different states’ MOCC initiation dates to account for asynchronous implementation. Degree of surge was derived from HHS hospital occupancy data and introduced as an interaction term. Findings were validated across key subset analyses.

Results: At least 12 states (AK, AZ, CO, GA, ID, MD, MN, NC, OR, UT, VA, and WA) reported establishing a state MOCC with a definitive start date, including eight initiated after May 2020 (post-first pandemic wave). Pre-MOCC initiation, a negative association was observed between surge and IFTs (Rate Ratio (RR) 0.61, 95% CI 0.51-0.72, p< 0.00001). MOCC establishment had an immediate positive effect on overall IFT rates at the average surge level (RR 4.78, 95% CI 1.93-11.84, p=0.00073) and reversed the surge-IFT relationship (RR 1.09, 95% CI 0.71-1.67, p = 0.71). Findings were consistent in rural, air transport, post-first wave, and highest acuity transfer subsets.

Conclusions: State MOCCs reversed concerning declines in interhospital transfers observed during pandemic surges, including for critically ill patients and in areas with limited healthcare infrastructure. Efforts to sustain MOCCs might improve access to care and outcomes during future crises and seasonal surges.