TY  - JOUR
PY  - 2018//
TI  - Insurance status biases trauma-system utilization and appropriate interfacility transfer: national and longitudinal results of adult, pediatric, and older adult patients
JO  - Annals of surgery
A1  - Zogg, Cheryl K.
A1  - Schuster, Kevin M.
A1  - Maung, Adrian A.
A1  - Davis, Kimberly A.
SP  - 681
EP  - 689
VL  - 268
IS  - 4
N2  - OBJECTIVE: To identify the association between insurance status and the probability of emergency department admission versus transfer for patients with major injuries (Injury Severity Score >15) and other complex trauma likely to require higher-level trauma center (TC) care across the spectrum of TC care. <br><br>BACKGROUND: Trauma systems were developed to facilitate direct transport and transfer of patients with major/complex traumatic injuries to designated TCs. Emerging literature suggests that uninsured patients are more likely to be transferred. <br><br>METHODS: Nationally weighted Nationwide Emergency Department Sample (2010-2014) and longitudinal California State Inpatient Databases/State Emergency Department Databases (2009-2011) data identified adult (18-64 yr), pediatric (≤17 yr), and older adult (≥65 yr) trauma patients. Risk-adjusted multilevel (mixed-effects) logistic regression determined differences in the relative odds of direct admission versus transfer and outcome measures based on initial level of TC presentation. <br><br>RESULTS: In all 3 age groups, insured patients were more likely to be admitted [eg, nontrauma center (NTC) private vs uninsured odds ratio (95% confidence interval): adult 1.54 (1.40-1.70), pediatric 1.95(1.45-2.61)]. The trend persisted within levels III and II TCs (eg, level II private vs uninsured adult 1.83 (1.30-2.57)] and among other forms of trauma likely to require transfer. At the state level, among transferred NTC patients, 28.5% (adult), 34.1% (pediatric), and 39.5% (older adult) of patients with major injuries were not transferred to level I/II TCs. An additional 44.3% (adult), 50.9% (pediatric), and 57.6% (older adult) of all NTC patients were never transferred. Directly admitted patients experienced higher morbidity [adult: 19.6% vs 8.2%, odds ratio (95% confidence interval):2.74 (2.17-3.46)] and mortality [3.3% vs 1.8%, 1.85 (1.13-3.04)]. <br><br>CONCLUSIONS: Insured patients with significant injuries initially evaluated at NTCs and level III/II TCs were less likely to be transferred. Such a finding appears to result in less optimal trauma care for better-insured patients and questions the success of transfer-guideline implementation.<p />  <p>Language: en</p>
LA  - en
SN  - 0003-4932
UR  - http://dx.doi.org/10.1097/SLA.0000000000002954
ID  - ref1
ER  -