Insurance status influences emergent designation in surgical transfers. J Surg Res 2016 Feb;200(2):579-85
Date
09/09/2015Pubmed ID
26346526Pubmed Central ID
PMC4691367DOI
10.1016/j.jss.2015.08.021Scopus ID
2-s2.0-84940873545 (requires institutional sign-in at Scopus site) 10 CitationsAbstract
BACKGROUND: There is a perception among surgeons that hospitals disproportionately transfer unfavorably insured patients for emergency surgical care. Emergency medical condition (EMC) designation mandates referral center acceptance of patients for whom transfer is requested. We sought to understand whether unfavorably insured patients are more likely to be designated as EMCs.
MATERIALS AND METHODS: A retrospective cohort study was performed on patient transfers from a large network of acute care facilities to emergency surgery services at a tertiary referral center from 2009-2013. Insurance was categorized as favorable (commercial or Medicare) or unfavorable (Medicaid or uninsured). The primary outcome, transfer designation as EMC or non-EMC, was evaluated using multivariable logistic regression. A secondary analysis evaluated uninsured patients only.
RESULTS: There were 1295 patient transfers in the study period. Twenty percent had unfavorable insurance. Favorably insured patients were older with fewer nonwhite, more comorbidities, greater illness severity, and more likely transferred for care continuity. More unfavorably insured patients were designated as EMCs (90% versus 84%, P < 0.01). In adjusted models, there was no association between unfavorable insurance and EMC transfer (odds ratio [OR], 1.61; 95% confidence interval [CI], 0.98-2.69). Uninsured patients were more likely to be designated as EMCs (OR, 2.27; CI, 1.08-4.77).
CONCLUSIONS: The finding that uninsured patients were more likely to be designated as EMCs suggests nonclinical variation that may be mitigated by clearer definitions and increased interfacility coordination to identify patients requiring transfer for EMCs.
Author List
Kummerow Broman K, Phillips S, Hayes RM, Ehrenfeld JM, Holzman MD, Sharp K, Kripalani S, Poulose BKAuthor
Jesse Ehrenfeld MD, MPH Sr Associate Dean, Director, Professor in the Advancing a Healthier Wisconsin Endowment department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AdultAged
Aged, 80 and over
Emergencies
Emergency Service, Hospital
Female
Humans
Insurance Coverage
Logistic Models
Male
Medicaid
Medically Uninsured
Medicare
Middle Aged
Patient Transfer
Retrospective Studies
Surgical Procedures, Operative
Tennessee
Tertiary Care Centers
United States
