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The American Journal of Managed Care September 2017
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Against the Current: Back-Transfer as a Mechanism for Rural Regionalization
Leah F. Nelson, MD, MS; Karisa K. Harland, PhD, MPH; Dan M. Shane, PhD; Azeemuddin Ahmed, MD, MBA; and Nicholas M. Mohr, MD, MS

Against the Current: Back-Transfer as a Mechanism for Rural Regionalization

Leah F. Nelson, MD, MS; Karisa K. Harland, PhD, MPH; Dan M. Shane, PhD; Azeemuddin Ahmed, MD, MBA; and Nicholas M. Mohr, MD, MS
The authors investigated back-transfer: the transfer of patients near the end of an acute hospitalization to a local community hospital for completion of their medical care.
Despite the rarity with which it is employed, back-transfer is a promising strategy that could better utilize health resources. Appropriate use of back-transfer could simultaneously maximize the availability of specialty services, support rural health systems, and move patients closer to their homes and families. There are several systematic barriers to widespread adoption of back-transfer in the United States, including policy, finance, logistics, and patient care concerns. Further work is needed to better understand the prevalence and outcomes of back-transfer in practice and the barriers impeding its expansion. 
The authors would like to thank Ann Showers, BBA; Joseph Clamon, JD; and Peggy O’Neill, RN, MSN, ACM, for sharing their expertise regarding the barriers to back-transfer. 

 Author Affiliations: University of Iowa Carver College of Medicine, (LFN), Iowa City, IA; Department of Emergency Medicine (KKH, AA, NMM), and Division of Critical Care, Department of Anesthesia (NMM), University of Iowa Carver College of Medicine, Iowa City, IA; Department of Health Management and Policy, University of Iowa College of Public Health (DMS), Iowa City, IA.

Source of Funding: The University of Iowa Department of Emergency Medicine funded this work. Dr. Mohr is additionally funded by grants from the Emergency Medicine Foundation and the Rural Telehealth Research Center, funded by the Federal Office of Rural Health Policy (Health Resources and Services Administration) grant number 1 U1C RH29074-01.

Author Disclosures: The authors report no relationship or financial interest with any entity that would pose a conflict of interest with the subject matter of this article.

Authorship Information: Concept and design (LFN, DMS, AA, NMM); acquisition of data (LFN, KKH); analysis and interpretation of data (LFN, KKH, NMM); drafting of the manuscript (LFN, KKH, DMS, AA, NMM); critical revision of the manuscript for important intellectual content (KKH, DMS, AA, NMM); statistical analysis (KKH, NMM); obtaining funding (NMM); administrative, technical, or logistic support (AA); and supervision (NMM).

Address Correspondence to: Nicholas M. Mohr, MD, MS, University of Iowa Carver College of Medicine, 200 Hawkins Dr, 1008 RCP, Iowa City, IA 52242. E-mail: 

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