David Metcalfe1, W Austin Davis2, Olubode A Olufajo2, Arturo J Rios-Diaz2, Muhammad A Chaudhary2, Mitchel B Harris3, Cheryl K Zogg2, Michael J Weaver3, Ali Salim4. 1. Center for Surgery and Public Health, Harvard Medical School, One Brigham Circle, Boston, Massachusetts; Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, John Radcliffe Hospital, Oxford, UK. 2. Center for Surgery and Public Health, Harvard Medical School, One Brigham Circle, Boston, Massachusetts. 3. Department of Orthopedic Surgery, Brigham & Women's Hospital, Boston, Massachusetts. 4. Center for Surgery and Public Health, Harvard Medical School, One Brigham Circle, Boston, Massachusetts; Division of Trauma, Burn, and Surgical Critical Care, Brigham & Women's Hospital, Boston, Massachusetts. Electronic address: asalim1@partners.org.
Abstract
BACKGROUND: Most hospitals in the United States are required to provide emergency care to all patients, regardless of insurance status. However, uninsured patients might be unable to access non-acute services, such as post-discharge inpatient care (PDIC). This could result in prolonged acute hospitalization. We tested the hypothesis that insurance status would be independently associated with both PDIC and length of stay (LOS). METHODS: An observational study was undertaken using the California State Inpatient Database (2007-2011), which captures 98% of patients admitted to hospital in California. All patients with a diagnosis of orthopedic lower limb trauma were identified using International Classification of Diseases, 9th Revision, Clinical Modification codes 820-828. Multivariable logistic and generalized linear regression models were used to adjust odds of PDIC and LOS for patient and hospital characteristics. RESULTS: There were 278,573 patients with orthopedic lower limb injuries, 160,828 (57.7%) of which received PDIC. Uninsured patients had lower odds of PDIC (adjusted odds ratio 0.20, 95% confidence interval 0.17-0.24) and significantly longer hospital LOS (predicted mean difference 1.06 [95% confidence interval 0.78-1.34] d) than those with private insurance. CONCLUSIONS: Lack of health insurance is associated with reduced access to PDIC and prolonged hospital LOS. This potential barrier to hospital discharge could reduce the number of trauma beds available for acutely injured patients.
BACKGROUND: Most hospitals in the United States are required to provide emergency care to all patients, regardless of insurance status. However, uninsured patients might be unable to access non-acute services, such as post-discharge inpatient care (PDIC). This could result in prolonged acute hospitalization. We tested the hypothesis that insurance status would be independently associated with both PDIC and length of stay (LOS). METHODS: An observational study was undertaken using the California State Inpatient Database (2007-2011), which captures 98% of patients admitted to hospital in California. All patients with a diagnosis of orthopedic lower limb trauma were identified using International Classification of Diseases, 9th Revision, Clinical Modification codes 820-828. Multivariable logistic and generalized linear regression models were used to adjust odds of PDIC and LOS for patient and hospital characteristics. RESULTS: There were 278,573 patients with orthopedic lower limb injuries, 160,828 (57.7%) of which received PDIC. Uninsured patients had lower odds of PDIC (adjusted odds ratio 0.20, 95% confidence interval 0.17-0.24) and significantly longer hospital LOS (predicted mean difference 1.06 [95% confidence interval 0.78-1.34] d) than those with private insurance. CONCLUSIONS: Lack of health insurance is associated with reduced access to PDIC and prolonged hospital LOS. This potential barrier to hospital discharge could reduce the number of trauma beds available for acutely injured patients.
Authors: David Metcalfe; Cheryl K Zogg; Elliott R Haut; Timothy M Pawlik; Adil H Haider; Daniel C Perry Journal: Int J Epidemiol Date: 2019-12-01 Impact factor: 7.196
Authors: Jeremy L Holzmacher; Kerry Townsend; Caleb Seavey; Stephanie Gannon; Mary Schroeder; Stephen Gondek; Lois Collins; Richard L Amdur; Babak Sarani Journal: JAMA Surg Date: 2017-10-01 Impact factor: 14.766