{"id":"https://openalex.org/W2912502005","doi":"https://doi.org/10.1097/sla.0000000000003208","title":"Local Referral of High-risk Patients to High-quality Hospitals","display_name":"Local Referral of High-risk Patients to High-quality Hospitals","publication_year":2019,"publication_date":"2019-01-21","ids":{"openalex":"https://openalex.org/W2912502005","doi":"https://doi.org/10.1097/sla.0000000000003208","mag":"2912502005","pmid":"https://pubmed.ncbi.nlm.nih.gov/30672794"},"language":"en","primary_location":{"id":"doi:10.1097/sla.0000000000003208","doi":"https://doi.org/10.1097/sla.0000000000003208","is_oa":false,"landing_page_url":"https://doi.org/10.1097/sla.0000000000003208","pdf_url":null,"source":{"id":"https://openalex.org/S157664895","display_name":"Annals of Surgery","issn_l":"0003-4932","issn":["0003-4932","1528-1140"],"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["anvur-scientific","cwts-core","dongbi-a","doyens","jufo-3","ki-jl-3","medline","norway-2","poland-200","russia-white-list-1","vabb-shw"],"host_organization":"https://openalex.org/P4310315671","host_organization_name":"Lippincott Williams & Wilkins","host_organization_lineage":["https://openalex.org/P4310315671","https://openalex.org/P4310318547"],"host_organization_lineage_names":["Lippincott Williams & Wilkins","Wolters Kluwer"],"type":"journal"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Annals of Surgery","raw_type":"journal-article"},"volume":null,"type":"article","indexed_in":["crossref","pubmed"],"open_access":{"is_oa":false,"oa_status":"closed","oa_url":null,"any_repository_has_fulltext":false},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5101937685","display_name":"Margaret Elizabeth Smith","orcid":"https://orcid.org/0000-0001-7315-8309","observed_orcids":["https://orcid.org/0000-0001-7315-8309"]},"institutions":[{"id":"https://openalex.org/I27837315","display_name":"University of Michigan","ror":"https://ror.org/00jmfr291","country_code":"US","type":"education","lineage":["https://openalex.org/I27837315"]}],"countries":["US"],"is_corresponding":true,"raw_author_name":"Margaret E. Smith","raw_affiliation_strings":["Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI","Department of Surgery, University of Michigan, Ann Arbor, MI"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI","institution_ids":["https://openalex.org/I27837315"]},{"raw_affiliation_string":"Department of Surgery, University of Michigan, Ann Arbor, MI","institution_ids":["https://openalex.org/I27837315"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5058947119","display_name":"Sarah P. Shubeck","orcid":"https://orcid.org/0000-0001-8831-2428","observed_orcids":["https://orcid.org/0000-0001-8831-2428"]},"institutions":[{"id":"https://openalex.org/I27837315","display_name":"University of Michigan","ror":"https://ror.org/00jmfr291","country_code":"US","type":"education","lineage":["https://openalex.org/I27837315"]}],"countries":["US"],"is_corresponding":true,"raw_author_name":"Sarah P. Shubeck","raw_affiliation_strings":["Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI","Department of Surgery, University of Michigan, Ann Arbor, MI"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI","institution_ids":["https://openalex.org/I27837315"]},{"raw_affiliation_string":"Department of Surgery, University of Michigan, Ann Arbor, MI","institution_ids":["https://openalex.org/I27837315"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5091589481","display_name":"Ushapoorna Nuliyalu","orcid":"https://orcid.org/0009-0006-5484-6839","observed_orcids":["https://orcid.org/0009-0006-5484-6839"]},"institutions":[{"id":"https://openalex.org/I27837315","display_name":"University of Michigan","ror":"https://ror.org/00jmfr291","country_code":"US","type":"education","lineage":["https://openalex.org/I27837315"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Ushapoorna Nuliyalu","raw_affiliation_strings":["Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI","institution_ids":["https://openalex.org/I27837315"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5069321101","display_name":"Justin Brigham Dimick","orcid":"https://orcid.org/0000-0002-4796-6641","observed_orcids":["https://orcid.org/0000-0002-4796-6641"]},"institutions":[{"id":"https://openalex.org/I27837315","display_name":"University of Michigan","ror":"https://ror.org/00jmfr291","country_code":"US","type":"education","lineage":["https://openalex.org/I27837315"]}],"countries":["US"],"is_corresponding":true,"raw_author_name":"Justin B. Dimick","raw_affiliation_strings":["Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI","Department of Surgery, University of Michigan, Ann Arbor, MI"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI","institution_ids":["https://openalex.org/I27837315"]},{"raw_affiliation_string":"Department of Surgery, University of Michigan, Ann Arbor, MI","institution_ids":["https://openalex.org/I27837315"]}]},{"author_position":"last","author":{"id":"https://openalex.org/A5103101943","display_name":"Hari Nathan","orcid":"https://orcid.org/0000-0001-7402-2403","observed_orcids":["https://orcid.org/0000-0001-7402-2403"]},"institutions":[{"id":"https://openalex.org/I27837315","display_name":"University of Michigan","ror":"https://ror.org/00jmfr291","country_code":"US","type":"education","lineage":["https://openalex.org/I27837315"]}],"countries":["US"],"is_corresponding":true,"raw_author_name":"Hari Nathan","raw_affiliation_strings":["Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI","Department of Surgery, University of Michigan, Ann Arbor, MI"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI","institution_ids":["https://openalex.org/I27837315"]},{"raw_affiliation_string":"Department of Surgery, University of Michigan, Ann Arbor, MI","institution_ids":["https://openalex.org/I27837315"]}]}],"institutions":[],"countries_distinct_count":1,"institutions_distinct_count":1,"corresponding_author_ids":["https://openalex.org/A5058947119","https://openalex.org/A5069321101","https://openalex.org/A5101937685","https://openalex.org/A5103101943"],"corresponding_institution_ids":["https://openalex.org/I27837315"],"apc_list":null,"apc_paid":null,"fwci":5.0165,"has_fulltext":false,"cited_by_count":25,"citation_normalized_percentile":{"value":0.95213458,"is_in_top_1_percent":false,"is_in_top_10_percent":true},"cited_by_percentile_year":{"min":88,"max":98},"biblio":{"volume":"271","issue":"6","first_page":"1065","last_page":"1071"},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T10391","display_name":"Healthcare Policy and Management","score":0.6625999808311462,"subfield":{"id":"https://openalex.org/subfields/2002","display_name":"Economics and Econometrics"},"field":{"id":"https://openalex.org/fields/20","display_name":"Economics, Econometrics and Finance"},"domain":{"id":"https://openalex.org/domains/2","display_name":"Social Sciences"}},"topics":[{"id":"https://openalex.org/T10391","display_name":"Healthcare Policy and Management","score":0.6625999808311462,"subfield":{"id":"https://openalex.org/subfields/2002","display_name":"Economics and Econometrics"},"field":{"id":"https://openalex.org/fields/20","display_name":"Economics, Econometrics and Finance"},"domain":{"id":"https://openalex.org/domains/2","display_name":"Social Sciences"}},{"id":"https://openalex.org/T12871","display_name":"Healthcare Quality and Management","score":0.24369999766349792,"subfield":{"id":"https://openalex.org/subfields/3605","display_name":"Health Information Management"},"field":{"id":"https://openalex.org/fields/36","display_name":"Health Professions"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T13555","display_name":"Healthcare cost, quality, practices","score":0.039000000804662704,"subfield":{"id":"https://openalex.org/subfields/3600","display_name":"General Health Professions"},"field":{"id":"https://openalex.org/fields/36","display_name":"Health Professions"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/selective-referral","display_name":"selective referral","score":0.6579999923706055},{"id":"https://openalex.org/keywords/high-risk-surgical-patients","display_name":"high-risk surgical patients","score":0.9129999876022339},{"id":"https://openalex.org/keywords/hospital-quality","display_name":"hospital quality","score":0.8050000071525574},{"id":"https://openalex.org/keywords/medicare-payments","display_name":"Medicare payments","score":0.7900000214576721},{"id":"https://openalex.org/keywords/postoperative-complications","display_name":"postoperative complications","score":0.9559999704360962},{"id":"https://openalex.org/keywords/elderly-patients","display_name":"elderly patients","score":0.6690000295639038},{"id":"https://openalex.org/keywords/geographic-variation-in-care","display_name":"regional variation in care","score":0.6499999761581421},{"id":"https://openalex.org/keywords/travel-distance-to-hospital","display_name":"travel distance to hospital","score":0.6919999718666077},{"id":"https://openalex.org/keywords/colectomy","display_name":"colectomy","score":0.9919999837875366},{"id":"https://openalex.org/keywords/lung-resection","display_name":"lung resection","score":0.984000027179718}],"concepts":[{"id":"https://openalex.org/C71924100","wikidata":"https://www.wikidata.org/wiki/Q11190","display_name":"Medicine","level":0,"score":0.9440302848815918},{"id":"https://openalex.org/C2776135927","wikidata":"https://www.wikidata.org/wiki/Q5242559","display_name":"Referral","level":2,"score":0.7702012062072754},{"id":"https://openalex.org/C194828623","wikidata":"https://www.wikidata.org/wiki/Q2861470","display_name":"Emergency medicine","level":1,"score":0.5791170597076416},{"id":"https://openalex.org/C2776667177","wikidata":"https://www.wikidata.org/wiki/Q1779148","display_name":"Colectomy","level":4,"score":0.4503515958786011},{"id":"https://openalex.org/C512399662","wikidata":"https://www.wikidata.org/wiki/Q3505712","display_name":"Family medicine","level":1,"score":0.21927577257156372},{"id":"https://openalex.org/C126322002","wikidata":"https://www.wikidata.org/wiki/Q11180","display_name":"Internal medicine","level":1,"score":0.1465359628200531},{"id":"https://openalex.org/C2779134260","wikidata":"https://www.wikidata.org/wiki/Q12136","display_name":"Disease","level":2,"score":0.08776673674583435},{"id":"https://openalex.org/C2780479503","wikidata":"https://www.wikidata.org/wiki/Q1477","display_name":"Ulcerative colitis","level":3,"score":0.0}],"mesh":[{"descriptor_ui":"D003082","descriptor_name":"Colectomy","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D005102","descriptor_name":"Health Expenditures","qualifier_ui":null,"qualifier_name":null,"is_major_topic":true},{"descriptor_ui":"D006278","descriptor_name":"Medicare","qualifier_ui":null,"qualifier_name":null,"is_major_topic":true},{"descriptor_ui":"D006761","descriptor_name":"Hospitals","qualifier_ui":"Q000592","qualifier_name":"standards","is_major_topic":true},{"descriptor_ui":"D006801","descriptor_name":"Humans","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D011183","descriptor_name":"Postoperative Complications","qualifier_ui":"Q000453","qualifier_name":"epidemiology","is_major_topic":true},{"descriptor_ui":"D011183","descriptor_name":"Postoperative Complications","qualifier_ui":"Q000517","qualifier_name":"prevention & control","is_major_topic":false},{"descriptor_ui":"D012017","descriptor_name":"Referral and Consultation","qualifier_ui":"Q000458","qualifier_name":"organization & administration","is_major_topic":true},{"descriptor_ui":"D012189","descriptor_name":"Retrospective Studies","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D014195","descriptor_name":"Travel","qualifier_ui":null,"qualifier_name":null,"is_major_topic":true},{"descriptor_ui":"D014481","descriptor_name":"United States","qualifier_ui":"Q000453","qualifier_name":"epidemiology","is_major_topic":false},{"descriptor_ui":"D015994","descriptor_name":"Incidence","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D016896","descriptor_name":"Treatment Outcome","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D017046","descriptor_name":"Cost Savings","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D017048","descriptor_name":"Health Care Costs","qualifier_ui":"Q000639","qualifier_name":"trends","is_major_topic":true},{"descriptor_ui":"D017050","descriptor_name":"Episode of Care","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false}],"locations_count":2,"locations":[{"id":"doi:10.1097/sla.0000000000003208","doi":"https://doi.org/10.1097/sla.0000000000003208","is_oa":false,"landing_page_url":"https://doi.org/10.1097/sla.0000000000003208","pdf_url":null,"source":{"id":"https://openalex.org/S157664895","display_name":"Annals of Surgery","issn_l":"0003-4932","issn":["0003-4932","1528-1140"],"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["anvur-scientific","cwts-core","dongbi-a","doyens","jufo-3","ki-jl-3","medline","norway-2","poland-200","russia-white-list-1","vabb-shw"],"host_organization":"https://openalex.org/P4310315671","host_organization_name":"Lippincott Williams & Wilkins","host_organization_lineage":["https://openalex.org/P4310315671","https://openalex.org/P4310318547"],"host_organization_lineage_names":["Lippincott Williams & Wilkins","Wolters Kluwer"],"type":"journal"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Annals of Surgery","raw_type":"journal-article"},{"id":"pmid:30672794","doi":null,"is_oa":false,"landing_page_url":"https://pubmed.ncbi.nlm.nih.gov/30672794","pdf_url":null,"source":{"id":"https://openalex.org/S4306525036","display_name":"PubMed","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":"https://openalex.org/I1299303238","host_organization_name":"National Institutes of Health","host_organization_lineage":["https://openalex.org/I1299303238"],"host_organization_lineage_names":[],"type":"repository"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Annals of surgery","raw_type":"Journal Article"}],"best_oa_location":null,"sustainable_development_goals":[{"score":0.98580002784729,"display_name":"Good health and well-being","id":"https://metadata.un.org/sdg/3"}],"study_designs":[{"display_name":"Observational Study","id":"https://openalex.org/study-designs/observational-study"}],"awards":[{"id":"https://openalex.org/G287093207","display_name":null,"funder_award_id":"R01-HS028606","funder_id":"https://openalex.org/F4320332177","funder_display_name":"Agency for Healthcare Research and Quality"},{"id":"https://openalex.org/G4112104809","display_name":null,"funder_award_id":"T32\u2010DK108740","funder_id":"https://openalex.org/F4320337357","funder_display_name":"National Institute of Diabetes and Digestive and Kidney Diseases"},{"id":"https://openalex.org/G5651085591","display_name":"Obesity & Gastrointestinal Surgery Research Training Program","funder_award_id":"5t32dk108740-07","funder_id":"https://openalex.org/F4320332161","funder_display_name":"National Institutes of Health"},{"id":"https://openalex.org/G625828343","display_name":null,"funder_award_id":"K08HS024763","funder_id":"https://openalex.org/F4320332177","funder_display_name":"Agency for Healthcare Research and Quality"},{"id":"https://openalex.org/G8349757977","display_name":"Evaluating Policies for Improving Surgical Care in the Elderly","funder_award_id":"R01AG039434","funder_id":"https://openalex.org/F4320337337","funder_display_name":"National Institute on Aging"}],"funders":[{"id":"https://openalex.org/F4320332161","display_name":"National Institutes of Health","ror":"https://ror.org/01cwqze88"},{"id":"https://openalex.org/F4320332177","display_name":"Agency for Healthcare Research and Quality","ror":"https://ror.org/03jmfdf59"},{"id":"https://openalex.org/F4320337337","display_name":"National Institute on Aging","ror":"https://ror.org/049v75w11"},{"id":"https://openalex.org/F4320337357","display_name":"National Institute of Diabetes and Digestive and Kidney Diseases","ror":"https://ror.org/00adh9b73"}],"has_content":{"pdf":false,"grobid_xml":false},"content_urls":null,"referenced_works_count":31,"referenced_works":["https://openalex.org/W66864636","https://openalex.org/W1113655846","https://openalex.org/W1974173658","https://openalex.org/W1979273288","https://openalex.org/W2000038546","https://openalex.org/W2001378660","https://openalex.org/W2028750332","https://openalex.org/W2032522800","https://openalex.org/W2045170415","https://openalex.org/W2057591158","https://openalex.org/W2057780602","https://openalex.org/W2060540484","https://openalex.org/W2073084758","https://openalex.org/W2081042264","https://openalex.org/W2140559517","https://openalex.org/W2154300715","https://openalex.org/W2166145010","https://openalex.org/W2169192944","https://openalex.org/W2215877897","https://openalex.org/W2317899051","https://openalex.org/W2320246461","https://openalex.org/W2322630401","https://openalex.org/W2396616467","https://openalex.org/W2514511068","https://openalex.org/W2520298348","https://openalex.org/W2746362655","https://openalex.org/W2770803077","https://openalex.org/W2790419754","https://openalex.org/W2901191295","https://openalex.org/W2996229413","https://openalex.org/W4231260784"],"related_works":["https://openalex.org/W2939100009","https://openalex.org/W2746362655","https://openalex.org/W7133225015","https://openalex.org/W2800290876","https://openalex.org/W2320246461","https://openalex.org/W4319915076","https://openalex.org/W2166145010","https://openalex.org/W2045170415","https://openalex.org/W2530821717","https://openalex.org/W4306178906"],"abstract_inverted_index":{"OBJECTIVE:":[0],"We":[1,83],"sought":[2],"to":[3,19,40,53,185,194,225,260],"assess":[4],"the":[5,55,72,130,171,231,275],"potential":[6],"changes":[7],"in":[8,36,177],"Medicare":[9,88,137,242],"payments":[10,138,243],"and":[11,100,112,151,153,200,206,241],"clinical":[12],"outcomes":[13],"of":[14,57,62,74,92,116,121,133,161,173,213,277],"referring":[15,37],"high-risk":[16,38,162,214,248,258],"surgical":[17,58,96,141,278],"patients":[18,39,63,163,184,215,249,259],"local":[20,75,187,252,261],"high-quality":[21,41,175,188,228,253,262],"hospitals":[22,42,155,219,263],"within":[23,67,264],"small":[24,68,179,265],"geographic":[25,69,180,266],"areas.":[26],"SUMMARY":[27],"BACKGROUND":[28],"DATA:":[29],"Previous":[30],"studies":[31],"have":[32],"documented":[33],"a":[34,44,51,134,167,174,186,222,227,271],"benefit":[35,73],"on":[43,86,119],"national":[45],"basis,":[46],"suggesting":[47],"selective":[48,76],"referral":[49,61,77],"as":[50,270],"mechanism":[52],"improve":[54],"value":[56,276],"care.":[59,279],"Practically,":[60],"should":[64],"be":[65],"done":[66],"regions;":[70],"however,":[71],"has":[78],"not":[79],"been":[80],"studied.":[81],"METHODS:":[82],"analyzed":[84],"data":[85],"elderly":[87],"beneficiaries":[89],"undergoing":[90],"any":[91],"4":[93],"elective":[94],"inpatient":[95],"procedures":[97],"between":[98,146],"2012":[99],"2014.":[101],"Hospitals":[102],"were":[103,143,156],"categorized":[104],"into":[105,114],"Metropolitan":[106],"Statistical":[107],"Areas":[108],"by":[109,128],"zip":[110,149],"code":[111,150],"stratified":[113],"quintiles":[115],"quality":[117],"based":[118],"rates":[120,240],"postoperative":[122,135],"complications.":[123],"Patient":[124],"risk":[125,132],"was":[126],"calculated":[127],"modeling":[129],"predicted":[131],"complication.":[136],"for":[139,197,204,208,247,273],"each":[140],"episode":[142],"calculated.":[144,157],"Distances":[145],"patients'":[147],"home":[148],"high-":[152],"low-quality":[154,168,218,232],"RESULTS:":[158],"One":[159],"quarter":[160],"underwent":[164],"surgery":[165],"at":[166,217,251],"hospital":[169,176,189,229,233],"despite":[170],"availability":[172],"their":[178],"area.":[181],"Shifting":[182],"these":[183],"would":[190],"decrease":[191],"spending":[192],"12%":[193],"37%":[195],"($2,500":[196],"total":[198],"knee":[199],"hip":[201],"replacement,":[202],"$6,700":[203],"colectomy,":[205],"$11,400":[207],"lung":[209],"resection).":[210],"Approximately":[211],"45%":[212],"treated":[216,250],"could":[220],"travel":[221],"shorter":[223],"distance":[224],"reach":[226],"than":[230],"they":[234],"received":[235],"care":[236],"at.":[237],"CONCLUSIONS:":[238],"Complication":[239],"are":[244],"significantly":[245],"lower":[246],"hospitals.":[254],"This":[255],"suggests":[256],"triaging":[257],"areas":[267],"may":[268],"serve":[269],"template":[272],"improving":[274]},"counts_by_year":[{"year":2025,"cited_by_count":3},{"year":2024,"cited_by_count":4},{"year":2023,"cited_by_count":1},{"year":2022,"cited_by_count":5},{"year":2021,"cited_by_count":2},{"year":2020,"cited_by_count":4},{"year":2019,"cited_by_count":6}],"updated_date":"2026-11-04T10:54:05.112534","created_date":"2019-02-21T00:00:00"}