Impact of institution of a stroke program upon referral bias at a rural academic medical center

Context: Referral bias reflected the preferential hospital transfer of patients with intracerebral contributing factor for an observed Kigh nonrisk-adjusted in-hospital crude acute stroke mortality rate at a rural academic medical center. Purpose: This study was done to assess the impact of a clinical acute stroke program upon referral bias in August 2000. Methods: A charts review of acute stroke (DRG 14) discharges during 2001 from a rural academic medical center was compared with the same data from 1999. Results: The odds ratio of ICH in hospital-transfer patients compared with, nonhospital-transfer patients decreased from 11.7 in 1999 to 3.2 in 2001 (P < .035). Conculsions: This study demonstrated the rapid magnitude and signifance that clinical programs can have upon referral bias. Changes in referral bias may be more rapid at rural academic medical centers because of the relative lasck of health care delivery competition.