C22-01 Tele-ICU Capability and the Value of Interhospital Transfers in Critically Ill Medicare Patients

Abstract Rationale Interhospital transfer of critically ill patients is often necessary for access to specialized services or higher-level expertise. However, transfers can impose clinical risk, disrupt continuity, and impose financial and emotional burdens for patients, families, and the U.S. healthcare system. Tele-intensive care unit (tele-ICU) programs extend critical care expertise to resource-limited hospitals and may influence transfer patterns by facilitating timely transfers for high-acuity patients or supporting local management and averting unnecessary transfers. However, the impact of tele-ICU adoption on transfer practices and post-transfer outcomes remains uncertain. Methods We conducted a retrospective cohort study using 2022-2023 Medicare claims linked with the American Hospital Association Annual Survey Database (AHAASD). Index ICU hospitalizations among Medicare beneficiaries were linked to interhospital ICU transfers. Tele-ICU capability at the originating hospital was defined by AHAASD reporting and/or ≥5 tele-ICU claims. The primary outcome was interhospital ICU transfer. Secondary outcomes included receipt of specialized procedures (cardiac catheterization, electroencephalography, endoscopy, extracorporeal membrane oxygenation, neurointerventional procedures, renal replacement therapy, or advanced surgical services), potentially low-value transfers (defined as death or hospice discharge within 1 day of transfer), in-hospital and 30-day mortality, and discharge disposition. Multilevel logistic regression models adjusted for demographics, comorbidities, acute organ failures, and hospital characteristics (rurality, critical access status, bed size, academic status, and ownership), with the originating hospital as a random intercept. Sensitivity analyses assessed tele-ICU delivery model and the interaction between tele-ICU presence and post-transfer specialty procedures. Results Among 2,424,927 ICU hospitalizations, 751,449 (31.0%) occurred at tele-ICU-capable hospitals. Transfer rates were similar at tele-ICU and non-tele-ICU hospitals (2.4% vs 2.6%), however adjusted odds of transfer were higher with tele-ICU capability (adjusted odds ratio aOR 1.11, 95% confidence interval CI 1.06-1.16). Rates of potentially low-value transfers were identical (4.6% vs 4.6%), however adjusted odds were lower with tele-ICU (aOR 0.83, 95% CI 0.75-0.93). Post-transfer outcomes were generally more favorable for patients originating from tele-ICU hospitals and among those receiving specialty procedures. Internal tele-ICU capability was associated with higher adjusted odds of transfer (aOR 1.20, 95% CI 1.13-1.28) and fewer low-value transfers (aOR 0.80, 95% CI 0.69-0.93) compared to those using health-system or third-party tele-ICU models. Conclusions After adjustment for patient and hospital factors, tele-ICU capability was associated with a higher likelihood of transfer but a lower likelihood of low-value transfer. Further work should examine how tele-ICU adoption influences transfer decision-making, value-aligned transfer practices, care continuity, and critical care delivery in resource-limited and other hospital contexts. This abstract is funded by: None