596. Clinical outcomes and healthcare utilization in uninsured patients requiring long-term antibiotic therapy

Abstract Background Outpatient parenteral antimicrobial therapy (OPAT) is frequently indicated in the management of severe bacterial infections. Uninsured patients may more have difficulties accessing OPAT services (compared to those with a payer source) which can lead to prolonged hospitalizations or early discharge with potentially suboptimal therapy. We sought to assess disparities in the care of hospitalized, uninsured patients who had an OPAT indication and to examine subsequent clinical outcomes. Methods We performed a retrospective analysis of consecutive patients admitted to an academic hospital from 09/01/2018-12/31/2018 who received an infectious diseases consultation and had an index diagnosis of endocarditis (IE), Staphylococcus aureus BSI, or bone and joint infection including osteomyelitis, prosthetic joint infection, and septic arthritis identified by ICD-10 code. Clinical data were collected during index admission; outcomes were followed for up to 30 days after discharge. We examined differences in length of stay (LOS), discharge against medical advice (AMA), and composite outcome of death and readmission at 30 days in uninsured and privately insured patients. Results Of 104 patients, 66 (63.5%) were privately insured and 38 (36.5%) were uninsured. Baseline clinical characteristics are presented in Table 1. Uninsured patients were younger (40.9 versus 51.4 years, p< 0.001) and more likely to be African American (55.3% versus 19.7%, p< 0.001). Uninsured patients were more likely to leave AMA (18.4% versus 0%, p=0.001), complete shorter duration of IV antibiotics (p=0.001), and receive oral antibiotics at discharge (15.8% versus 3.0%, p=0.049). Length of stay was numerically longer in this group although not significant (15.5 days versus 10 days, p=0.053). Composite outcome of readmission or death from all cause at 30 days was lower in the uninsured group; however, after adjusting for age, the results were not significant (aOR 0.372, 95% CI 0.106-1.297, p=0.121). Table 1. Demographic and clinical characteristics of privately insured and uninsured patients Conclusion Uninsured patients were more likely to leave AMA, complete shorter duration of IV antibiotics, and receive oral antibiotics at discharge compared with privately insured patients. Thirty-day readmission and death rates were not significantly different among the two groups. Disclosures All Authors: No reported disclosures

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Association between Insurance Status and Hospital Length of Stay following Trauma

The American Surgeon ◽

10.1177/000313481608200324 ◽

2016 ◽

Vol 82 (3) ◽

pp. 281-288 ◽

Cited By ~ 9

Author(s):

Brian R. Englum ◽

Xuan Hui ◽

Cheryl K. Zogg ◽

Muhammad Ali Chaudhary ◽

Cassandra Villegas ◽

...

Keyword(s):

Length Of Stay ◽

Injury Severity ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Insurance Status ◽

Trauma Patients ◽

Uninsured Patients ◽

National Trauma ◽

Insured Patients ◽

The Relationship

Previous research has demonstrated that nonclinical factors are associated with differences in clinical care, with uninsured patients receiving decreased resource use. Studies on trauma populations have also shown unclear relationships between insurance status and hospital length of stay (LOS), a commonly used metric for evaluating quality of care. The objective of this study is to define the relationship between insurance status and LOS after trauma using the largest available national trauma dataset and controlling for significant confounders. Data from 2007 to 2010 National Trauma Data Bank were used to compare differences in LOS among three insurance groups: privately insured, publically insured, and uninsured trauma patients. Multivariable regression models adjusted for potential confounding due to baseline differences in injury severity and demographic and clinical factors. A total of 884,493 patients met the inclusion criteria. After adjusting for the influence of covariates, uninsured patients had significantly shorter hospital stays (0.3 days) relative to privately insured patients. Publicly insured patients had longer risk-adjusted LOS (0.9 days). Stratified differences in discharge disposition and injury severity significantly altered the relationship between insurance status and LOS. In conclusion, this study elucidates the association between insurance status and hospital LOS, demonstrating that a patient's ability to pay could alter LOS in acute trauma patients. Additional research is needed to examine causes and outcomes from these differences to increase efficiency in the health care system, decrease costs, and shrink disparities in health outcomes.

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Etiology and Impact of Coinfections in Children Hospitalized With Community-Acquired Pneumonia

The Journal of Infectious Diseases ◽

10.1093/infdis/jix641 ◽

2017 ◽

Vol 218 (2) ◽

pp. 179-188 ◽

Cited By ~ 25

Author(s):

Vikki G Nolan ◽

Sandra R Arnold ◽

Anna M Bramley ◽

Krow Ampofo ◽

Derek J Williams ◽

...

Keyword(s):

Intensive Care Unit ◽

Mechanical Ventilation ◽

Intensive Care ◽

Length Of Stay ◽

Intensive Care Unit Admission ◽

Bacterial Infections ◽

Clinical Characteristics ◽

Community Acquired Pneumonia ◽

Virus Infections ◽

Oxygen Supplementation

Abstract Background Recognition that coinfections are common in children with community-acquired pneumonia (CAP) is increasing, but gaps remain in our understanding of their frequency and importance. Methods We analyzed data from 2219 children hospitalized with CAP and compared demographic and clinical characteristics and outcomes between groups with viruses alone, bacteria alone, or coinfections. We also assessed the frequency of selected pairings of codetected pathogens and their clinical characteristics. Results A total of 576 children (26%) had a coinfection. Children with only virus detected were younger, more likely to be black, and more likely to have comorbidities such as asthma, compared with children infected with typical bacteria alone. Children with virus-bacterium coinfections had a higher frequency of leukocytosis, consolidation on chest radiography, parapneumonic effusions, intensive care unit admission, and need for mechanical ventilation and an increased length of stay, compared with children infected with viruses alone. Virus-virus coinfections were generally comparable to single-virus infections, with the exception of the need for oxygen supplementation, which was higher during the first 24 hours of hospitalization in some virus-virus pairings. Conclusions Coinfections occurred in 26% of children hospitalized for CAP. Children with typical bacterial infections, alone or complicated by a viral infection, have worse outcomes than children infected with a virus alone.

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Patient- and provider-level predictors of mortality among patients with metastatic renal cell carcinoma receiving oral anticancer agents.

Journal of Clinical Oncology ◽

10.1200/jco.2020.39.28_suppl.116 ◽

2021 ◽

Vol 39 (28_suppl) ◽

pp. 116-116

Author(s):

Lisa Spees ◽

Michaela Ann Dinan ◽

Bradford E. Jackson ◽

Christopher Baggett ◽

Lauren E. Wilson ◽

...

Keyword(s):

Renal Cell Carcinoma ◽

Cell Carcinoma ◽

Metastatic Renal Cell Carcinoma ◽

Renal Cell ◽

Clinical Characteristics ◽

De Novo ◽

Metastatic Cancer ◽

All Cause Mortality ◽

Insured Patients ◽

Privately Insured

116 Background: It is important to understand how emerging new therapies, such as oral anti-cancer agents (OAAs), diffuse across and can improve outcomes within real-world populations, which include age groups and racial groups not well-represented in clinical trials, such as people older than age 65 and Black patients. Our objectives were to examine whether disparities in mortality persist among patients with metastatic renal cell carcinoma (mRCC) receiving OAAs and whether these disparities may be partially explained by patient’s clinical characteristics or provider-level factors. Methods: We used linked state cancer registry data and multi-payer claims data to identify patients with mRCC who were diagnosed in 2004 through 2015 and had initiated an OAA and survived ≥ 90 days after initiating. Provider data were obtained from North Carolina Health Professions Data System and the National Plan & Provider Enumeration System. A patient’s modal provider was the provider most frequently on claims with a diagnosis code of RCC or metastatic cancer between 2 months prior to and 3 months following the index date. We estimated hazard ratios (HR) and corresponding 95% confidence limits (CL) using Cox proportional hazard models to evaluate which patient demographics, patient clinical characteristics, and provider-level factors were associated with 2-year all-cause mortality. Results: The cohort included 207 patients with mRCC. In unadjusted analyses, public insurance (Medicaid or Medicare), de novo metastatic diagnosis, frailty, polypharmacy, and a visit to a skilled nursing facility were associated with increased all-cause mortality. In multivariable models, clinical variables such as frailty (HR: 1.36, 95% CL: 1.11-1.67) and de novo metastatic diagnosis (HR: 2.63, 95%CL: 1.67-4.16) were associated with higher all-cause mortality. Additionally, Medicare-insured patients continued to have higher all-cause mortality compared to privately insured patients (HR: 2.35, 95% CL: 1.32-4.18). None of the provider-level covariates (i.e., specialization, experience, volume, or practice location) investigated were associated with all-cause mortality. Conclusions: Even when adjusting for age, frailty, and comorbidities, Medicare-insured patient had lower overall survival than privately-insured patients. Patient survival did not differ based on modal provider’s characteristics.

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Comparison of the Yield of Colonoscopy among Uninsured Patients Who Benefitted from the Free DC Screen for Life Program and Privately Insured Patients

The American Journal of Gastroenterology ◽

10.14309/00000434-201210001-01945 ◽

2012 ◽

Vol 107 ◽

pp. S792

Author(s):

Adeyinka Laiyemo ◽

Chukwuma Umunakwe ◽

Andrew Sanderson ◽

Rehana Begum ◽

Tia Montgomery ◽

...

Keyword(s):

Uninsured Patients ◽

Insured Patients ◽

Privately Insured

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Comparative effectiveness study of chemotherapy in follicular lymphoma patients in the rituximab era: a Japanese claims database study

Future Oncology ◽

10.2217/fon-2020-0832 ◽

2020 ◽

Author(s):

Saaya Tsutsué ◽

Kensei Tobinai ◽

Jingbo Yi ◽

Bruce Crawford

Keyword(s):

Length Of Stay ◽

Propensity Score ◽

Follicular Lymphoma ◽

Clinical Outcomes ◽

Comparative Effectiveness ◽

Clinical Characteristics ◽

First Year ◽

Effectiveness Study ◽

Claims Database ◽

Comparative Effectiveness Study

Aim: To evaluate comparative effectiveness of rituximub (R)-based versus non-R-based therapies for follicular lymphoma patients in Japan, where limited studies have been reported. Materials & methods: Patients who received R-based index regimens were propensity score matched to those who did not receive R, based on patient baseline attributes and clinical characteristics using Japanese retrospective claims database to assess clinical and economic outcomes. Results & conclusion: A total of 1947 patients remained in the overall follicular lymphoma cohorts: 1294 receiving an R-based and 653 a non-R-based regimen. Patients on R-based therapy underwent fewer hospitalizations and had a shorter length of stay, but had higher costs during the first year of intensive R-based therapy. Improved clinical outcomes were associated with patients who were younger, female and chose R-based regimens in first index line.

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Effect of the COVID-19 pandemic on health insurance coverage among trauma patients: a study of six level I trauma centers

Trauma Surgery & Acute Care Open ◽

10.1136/tsaco-2020-000640 ◽

2021 ◽

Vol 6 (1) ◽

pp. e000640

Author(s):

Erica Sercy ◽

Therese M Duane ◽

Mark Lieser ◽

Robert M Madayag ◽

Gina Berg ◽

...

Keyword(s):

Health Insurance ◽

Clinical Characteristics ◽

Insurance Coverage ◽

Health Insurance Coverage ◽

Trauma Patients ◽

Trauma Centers ◽

Insurance Type ◽

Period 2 ◽

Insured Patients ◽

Privately Insured

BackgroundIncreased unemployment during the COVID-19 pandemic has likely led to widespread loss of employer-provided health insurance. This study examined trends in health insurance coverage among trauma patients during the COVID-19 pandemic, including differences in demographics and clinical characteristics by insurance type.MethodsThis was a retrospective study on adult patients admitted to six level 1 trauma centers between January 1, 2018 and June 30, 2020. The primary exposure was hospital admission date: January 1, 2018 to December 31, 2018 (Period 1), January 1, 2019 to March 15, 2020 (Period 2), and March 16, 2020 to June 30, 2020 (Period 3). Covariates included demographic and clinical variables. χ² tests examined whether the rates of patients covered by each insurance type differed between the pandemic and earlier periods. Mann-Whiney U and χ² tests investigated whether patient demographics or clinical characteristics differed within each insurance type across the study periods.ResultsA total of 31 225 trauma patients admitted between January 1, 2018 and June 30, 2019 were included. Forty-one per cent (n=12 651) were admitted in Period 1, 49% (n=15 258) were from Period 2, and 11% (n=3288) were from Period 3. Percentages of uninsured patients increased significantly across the three periods (Periods 1 to 3: 15%, 16%, 21%) (ptrend=0.02); however, there was no accompanying decrease in the percentages of commercial/privately insured patients (Periods 1 to 3: 40%, 39%, 39%) (ptrend=0.27). There was a significant decrease in the percentage of patients on Medicare during the pandemic period (Periods 1 to 3: 39%, 39%, 34%) (p<0.01).DiscussionThis study found that job loss during the COVID-19 pandemic resulted in increases of uninsured trauma patients. However, there was not a corresponding decrease in commercial/privately insured patients, as may have been expected; rather, a decrease in Medicare patients was observed. These findings may be attributable to a growing workforce during the study period, in combination with a younger overall patient population during the pandemic.Level of evidenceRetrospective, level III study.

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6 Burn Patient Insurance Status Influences Hospital Discharge Disposition Locations

Journal of Burn Care & Research ◽

10.1093/jbcr/irab032.011 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

pp. S10-S10

Author(s):

Ian F Hulsebos ◽

Maxwell B Johnson ◽

Leigh J Spera ◽

Elise M Hulsebos ◽

Haig A Yenikomshian ◽

...

Keyword(s):

Wound Care ◽

Post Discharge ◽

Uninsured Patients ◽

Discharge Location ◽

Publicly Insured ◽

Insured Patients ◽

To Receive ◽

Privately Insured

Abstract Introduction Post-discharge services, such as outpatient wound care, may affect long term health outcomes and post-recovery quality of life. Access to these services may vary according to insurance status and ability to withstand out-of-pocket expenses. Our objective was to compare discharge location between burn patients who were uninsured, publicly insured, or privately insured at the time of their burn unit admissions. We hypothesized that uninsured patients were more likely to be discharged to locations with fewer wound care resources. Methods A retrospective review from July 1, 2015 to November 1, 2019 was performed at an ABA-verified burn center. All inpatient burn admission patients were identified and categorized according to insurance payer type. Patient and burn characteristics were recorded. The primary outcome was discharge location, and secondary outcomes included readmission and outpatient burn care attendance. Results In total, 284 uninsured, 565 publicly insured and 293 privately insured patients were identified. There were no significant differences in TBSA (P=0.3), presence of full thickness burn (P=0.3), inhalation injury (P=0.3), ICU days (P=0.09), ventilator days (P=0.2), or need for grafting (P=0.1). Uninsured patients were found to be younger (P< 0.0001) and more likely to be male (P=0.03). For primary outcome, uninsured patients were more likely to be discharged without ancillary services (self-care) (80.3% vs. 66.7% vs. 66.9%, P< 0.0001). Publicly insured patients were more likely to receive skilled nursing care (1.1% vs. 6.6% vs. 2.4%, P=0.0007). Privately insured patients were more likely to receive homecare (3.2% vs. 5.8% vs. 10.9%, P=0.0005) or transfer to other institutions for ongoing inpatient care (2.5% vs. 5.1% vs. 11.6%, P< 0.0001). For secondary outcomes, there was no difference in burn unit readmission (P=0.5) while uninsured were more likely to follow up in the same institution’s outpatient burn clinic after discharge (82.4% vs. 72.0% vs. 75.4%, P=0.004). Conclusions Despite no differences in burn injury severity, uninsured patients were less likely to receive post-discharge resources. However, these patients were younger, which may partially explain their disproportionate discharge to self-care. Nevertheless, insured patients have greater access to non-emergent medical resources and a broader range of treatment options. Although there were no significant differences in hospital readmission, the long-term implication to differential post-discharge care is unknown. Additional studies are needed to better elucidate if discrepancies in long-term wound healing or perceived quality of life amongst these populations exist.

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The Effect Of Insurance Status and Comorbidities On Outcomes After Splenectomy Among Patients With ITP

Blood ◽

10.1182/blood.v122.21.3560.3560 ◽

2013 ◽

Vol 122 (21) ◽

pp. 3560-3560

Author(s):

Gaurav Kistangari ◽

Keith R. McCrae ◽

Swapna Thota ◽

Nicholas Schiltz ◽

Siran M Koroukian

Keyword(s):

Length Of Stay ◽

Postoperative Mortality ◽

Mortality Rates ◽

Insurance Status ◽

Inpatient Mortality ◽

Comorbid Conditions ◽

Insurance Type ◽

Insured Patients ◽

Privately Insured

Abstract Background Importance of individual’s insurance status in access and quality of health care has been well documented in published literature. Lack of or inadequate insurance may be associated with negative health consequences. Currently there are no studies that have examined the relation between the insurance status and splenectomy outcomes among patients with Immune thrombocytopenia (ITP) Splenectomy has been the standard second-line treatment for adults with ITP for several decades. Recently published guidelines by American Society of Hematology for the management of ITP gave splenectomy a strong recommendation based on its sustained remission rates and long-term experience. Despite its effectiveness in achieving durable response, there has been a tendency among physicians to avoid or delay splenectomy due to the fear of removing a healthy organ, a long-term risk of sepsis and mortality associated with surgery. Previously reported mortality rates for splenectomy in ITP were around 0.2 - 1%. However, the effect of insurance status and the prevalence of common comorbidities that can influence postoperative outcomes have not been explored in this population. The following study, representative of a national cohort of ITP patients who underwent splenectomy, assesses the effect of insurance type and comorbidities on postoperative mortality and length of stay in hospital following splenectomy. We hypothesized that uninsured or federally funded health insurance and underlying comorbidities might have an unfavorable effect on the outcomes. Methods Within the Health Care Utilization Project Nationwide Inpatient Sample (NIS), we identified 9419 (n=9419) patients who underwent splenectomy for ITP between 2004-2009. The presence of comorbidities was assessed based on Elixhauser’s comorbid conditions and patients were categorized based on presence of ≥ 3, ≥2 or ≤1 comorbid conditions. Multiple logistic regression analyses was performed to evaluate the effect of insurance type on inpatient mortality rate after adjusting for age, sex, race, and number of comorbidities. Furthermore, the effect of comorbidities on inpatient mortality was analyzed after adjusting for other variables such as age, type of insurance and race. Hospital length of stay (LOS) was dichotomized as prolonged if LOS > 9 days (third quartile) or short if LOS< 9 days. The study protocol was approved by Case Western Reserve University Institutional Review Board. Results During the six-year period between 2004-2009, a weighted estimate of 9419 patients were identified who underwent splenectomy for ITP. Inpatient postoperative mortality was 3.1% and overall median LOS was 9 days. Most patients were privately insured (47.6%), followed by Medicare (35.1%), Medicaid (8.6%) and uninsured (8.5%). 2% of Medicare, 0.2% of Medicaid, 0.7% of uninsured and 0.16% of privately insured patients died. On multivariable analysis there was no significant difference in mortality among Medicare, Medicaid and uninsured patients when compared to privately insured patients. Medicaid patients had prolonged length of stay as compared to privately insured patients (aOR 2.55, CI 1.71-3.79, P< 0.0001). Patients with higher comorbidities had higher mortality rates and length of stay after adjusting for age, race and insurance type. Patients with ≥ 3 comorbid conditions were three times more likely to die (aOR 3.03, CI 1.4-6.2, p<0.01) and six times more likely to have prolonged hospital stay (aOR 6.4, CI 4.8-8.6, p<0.001) as compared to patients with ≤1 comorbid condition. Conclusion Patients who are privately insured have similar mortality rates as compared to Medicare and Medicaid and uninsured population. Preoperative comorbidities are associated with increased risk of mortality, and risk adjustment is necessary while evaluating patients with ITP undergoing splenectomy. Disclosures: No relevant conflicts of interest to declare.

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Survival Outcomes for US and Canadian Patients Diagnosed with Hodgkin Lymphoma before and after Brentuximab Vedotin Approval for Relapsed/Refractory Disease: A Retrospective Cohort Study

Blood ◽

10.1182/blood-2020-136356 ◽

2020 ◽

Vol 136 (Supplement 1) ◽

pp. 3-4

Author(s):

Gwynivere A Davies ◽

John E. Orav ◽

Kristen Brantley

Keyword(s):

Brentuximab Vedotin ◽

Insurance Status ◽

Uninsured Patients ◽

Risk Of Death ◽

Period 2 ◽

Fda Approval ◽

The Us ◽

Insured Patients ◽

Privately Insured

Background: Insurance status impacts access and survival for cancer patients within mixed healthcare systems, such as the US (Walker et al., 2014). Universal healthcare, as in Canada, provides broad coverage, though new drug funding is delayed for financial evaluations given escalating costs of oncologic therapies. Brentuximab Vedotin (BV) was the first FDA approved medication (2011) for Hodgkin lymphoma (HL) since 1977, with a 75% response rate and median overall survival (OS) 40.5 months in patients relapsing post transplant, compared to OS 10.5 to 27.6 months with prior therapies (Chen et al., 2016). Approximately 20% of HL patients develop refractory/relapsed disease, and most proceed to transplant; a further 50% relapse however, thus effective therapy is critical. Given the cost ($232 320 CAD per course; pCODR, 2018), an extensive cost-efficacy analysis was completed in Canada prior to funding, leading to a 3 year delay compared to FDA approval and US funding. We therefore compared OS for US and Canadian patients diagnosed with HL pre/post FDA approval of BV for post-transplant relapse, hypothesizing that 1) survival differences within the US according to insurance would be present and widen after approval and 2) a survival gap would emerge between privately insured US vs. Canadian patients. Methods: A retrospective cohort study was performed of patients 16-64 years diagnosed with classical HL in 2007-2010 (period 1) or 2011-2014 (period 2) from the US SEER and Canadian Cancer Registry (CCR), with vital status updated to November 2016 and December 31, 2014 respectively. A surrogate date for access (FDA approval) was used as neither dataset captures chemotherapy. Exclusion criteria included missing histology, follow-up or insurance data, or post-mortem diagnosis. Log-rank test and Kaplan-Meier analysis compared OS (primary outcome) between groups: in period 2 vs. 1 by US insurance status (aim 1) and including a Canadian/universal category (aim 2). Analysis was performed within each dataset to allow for maximal adjustment utilizing Cox proportional hazards by covariates (age, gender, insurance status, stage, lymphoma subtype, race, ethnicity, marital status within SEER; age, gender, subtype within CCR), then merged using common variables. Secondary outcomes examined 36-month OS (longest calculable given censoring dates) to compare the direction and degree of change in survival between time periods. Results: 12,003 US and 4,210 Canadian patients were included. Demographics were similar, though follow up was shorter for the latter due to censoring date. US patients demonstrated improved survival (crude HR=0.90 (95%CI 0.80-1.02), adjusted HR=0.80 (95%CI 0.71-0.91)), between periods. Canadian patients had a similar reduced risk of death between periods, though this became statistically insignificant after adjustment (crude HR=0.72 (95%CI 0.54-0.95), adjusted HR=0.77 (95%CI 0.59-1.02)). Comparing all patients by country (periods combined) demonstrated a non-significant increased crude risk of death in US vs. Canadian patients (HR 1.13, p=0.059, 95% CI 1.00-1.27). Stratifying US patients by insurance demonstrated stable OS for privately insured, significantly improved OS for Medicaid and non-significantly worse survival for uninsured patients, demonstrating divergence by time likely not solely due to BV access. No difference in OS improvement occurred between periods for privately insured vs. universal patients. In an adjusted model including time period, compared with universal there was increased risk for both uninsured (HR 1.80, p<0.0001, 95% CI 1.46-2.20) and Medicaid patients (HR 2.36, p<0.0001, 95% CI 2.02-2.76), and reduced risk in privately insured patients (HR 0.87, p=0.044, 95% CI 0.77-1.00). Unadjusted 36-month OS quantified divergence according to insurance, with a large (+7.4%) and small (+2.4%) improvement in Medicaid and universal patients respectively, no change in privately insured and worse survival (-4.1%) for uninsured patients. Conclusions: HL survival was worse for Medicaid/uninsured compared to privately/universally insured patients, however all had stable or improved survival in period 2 except uninsured patients. No difference in change between periods for privately or universally insured patients occurred due to delayed access, however robust datasets capturing chemotherapy and comorbidities are needed. Disclosures Davies: Novartis: Honoraria; TEVA: Honoraria.

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Burn Patient Insurance Status Influences Hospital Discharge Disposition and Utilization of Post-Discharge Outpatient Care

Journal of Burn Care & Research ◽

10.1093/jbcr/irab124 ◽

2021 ◽

Author(s):

Ian F Hulsebos ◽

Zachary J Collier ◽

Leigh J Spera ◽

Maxwell B Johnson ◽

Elise M Hulsebos ◽

...

Keyword(s):

Primary Outcome ◽

Wound Care ◽

Post Discharge ◽

Uninsured Patients ◽

Discharge Location ◽

Publicly Insured ◽

Insured Patients ◽

To Receive ◽

Privately Insured

Abstract Post-discharge services, such as outpatient wound care, may affect long term health outcomes and post-recovery quality of life. Access to these services may vary according to insurance status and ability to withstand out-of-pocket expenses. Our objective was to compare discharge location between burn patients who were uninsured, publicly insured, or privately insured at the time of their burn unit admissions. A retrospective review from July 1, 2015 to November 1, 2019 was performed at an ABA-verified burn center. All inpatient burn admission patients were identified and categorized according to insurance payer type. The primary outcome was discharge location, and secondary outcomes included readmission and outpatient burn care attendance. In total, 284 uninsured, 565 publicly insured and 293 privately insured patients were identified. There were no significant differences in TBSA (P=0.3), inhalation injury (P=0.3), ICU days (P=0.09), or need for grafting (P=0.1). For primary outcome, uninsured patients were more likely to be discharged without ancillary services(P<0.0001). Publicly insured patients were more likely to receive skilled nursing care (P=0.0007). Privately insured patients were more likely to receive homecare (P=0.0005) or transfer for ongoing inpatient care (P<0.0001). There was no difference in burn unit readmission (P=0.5); uninsured were more likely to follow up with outpatient burn clinic after discharge (P=0.004). Uninsured patients were less likely to receive post-discharge resources. Uninsured patients receive fewer post-discharge wound care resources which could result in suboptimal long-term results, and diminished return to pre-injury functional status. Increased access to post-discharge resources will provide comprehensive care to more patients.

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