Key points are not available for this paper at this time.
The US health care system relies on highly resourced tertiary and quaternary hospitals receiving patients from hospitals that are unable to provide these levels of specialty care. These latter hospitals, often in sparsely populated rural areas or underresourced urban areas, are typically not equipped to provide the consultative, procedural, and surgical expertise found in larger systems.
Mitchell et al. (Fri,) studied this question.