Insurance Status Impacts Hospital Discharge for Penetrating Trauma Survivors

2021 ◽  
pp. 000313482110233
Author(s):  
Samantha N. Olafson ◽  
Ryan B. Cohen ◽  
Afshin Parsikia ◽  
Benjamin Moran ◽  
Mark J. Kaplan ◽  
...  
Keyword(s):  
Hospital Discharge ◽  
Penetrating Trauma ◽  
Hospital Length Of Stay ◽  
Trauma Survivors ◽  
Insurance Status ◽  
Trauma Patients ◽  
Discharge Destination ◽  
Skilled Nursing ◽  
Severity Of Injury

Background Despite equalized acute care in trauma, disparities exist in the long-term outcomes of trauma survivors. Prior studies have revealed insurance status plays a role in the discharge destination of blunt trauma survivors. This is yet to be described in patients with penetrating traumatic injury. Methods A retrospective chart review from 2009 to 2019 from an urban Level 1 trauma center identified adult patients who survived penetrating trauma to discharge. Patients were categorized by insurance status. Patient demographics, discharge destination, and hospital length of stay (LOS) were analyzed using the t-test and ANOVA. Results 1806 patients were identified with 1410 survivors to hospital discharge. Among the survivors, 26.8% were uninsured, 13.1% were privately insured, and 60.0% had Medicare/Medicaid. The uninsured patients were significantly less likely to be discharged to a rehabilitation facility or skilled nursing facility (OR = .49, 95% CI .35-.71) compared to the insured patients. Uninsured survivors had shorter LOS compared to the other groups (5.8 vs. 7.3, P < .01.) Severity of injury did not significantly influence the discharge destination or LOS between the groups. Conclusion Despite recent health care reform, many trauma patients remain uninsured. Our study shows that uninsured penetrating trauma survivors are less likely to be discharged to rehabilitation and skilled nursing facilities. This may contribute to uninsured trauma survivors not receiving appropriate post-traumatic care and could lead to the accrual of undue disability, long-term complications, and increased societal burdens.

scholarly journals Insurance Status Impacts Hospital Discharge for Penetrating Trauma Survivors: One Decade of Experience From an Urban Level I Trauma Center

2021 ◽  
Vol 233 (5) ◽  
pp. e219
Author(s):  
Samantha N. Olafson ◽  
Ryan Cohen ◽  
Pak Shan P. Leung ◽  
Benjamin Moran ◽  
Afshin Parsikia ◽  
...  
Keyword(s):  
Hospital Discharge ◽  
Trauma Center ◽  
Penetrating Trauma ◽  
Trauma Survivors ◽  
Insurance Status ◽  
Urban Level ◽  
Level I

scholarly journals Introduction of a standardised protocol, including systematic use of tranexamic acid, for management of severe adult trauma patients in a low-resource setting: the MSF experience from Port-au-Prince, Haiti

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Alessandro Jachetti ◽  
Rose Berly Massénat ◽  
Nathalie Edema ◽  
Sophia C. Woolley ◽  
Guido Benedetti ◽  
...  
Keyword(s):  
Tranexamic Acid ◽  
Traumatic Event ◽  
Penetrating Trauma ◽  
Hospital Length Of Stay ◽  
Trauma Patients ◽  
Early Administration ◽  
Massive Haemorrhage ◽  
Low Resource ◽  
Resource Setting ◽  
Before And After

Abstract Background Bleeding is an important cause of death in trauma victims. In 2010, the CRASH-2 study, a multicentre randomized control trial on the effect of tranexamic acid (TXA) administration to trauma patients with suspected significant bleeding, reported a decreased mortality in randomized patients compared to placebo. Currently, no evidence on the use of TXA in humanitarian, low-resource settings is available. We aimed to measure the hospital outcomes of adult patients with severe traumatic bleeding in the Médecins Sans Frontières Tabarre Trauma Centre in Port-au-Prince, Haiti, before and after the implementation of a Massive Haemorrhage protocol including systematic early administration of TXA. Methods Patients admitted over comparable periods of four months (December2015- March2016 and December2016 - March2017) before and after the implementation of the Massive Haemorrhage protocol were investigated. Included patients had blunt or penetrating trauma, a South Africa Triage Score ≥ 7, were aged 18–65 years and were admitted within 3 h from the traumatic event. Measured outcomes were hospital mortality and early mortality rates, in-hospital time to discharge and time to discharge from intensive care unit. Results One-hundred and sixteen patients met inclusion criteria. Patients treated after the introduction of the Massive Haemorrhage protocol had about 70% less chance of death during hospitalization compared to the group “before” (adjusted odds ratio 0.3, 95%confidence interval 0.1–0.8). They also had a significantly shorter hospital length of stay (p = 0.02). Conclusions Implementing a Massive Haemorrhage protocol including early administration of TXA was associated with the reduced mortality and hospital stay of severe adult blunt and penetrating trauma patients in a context with poor resources and limited availability of blood products.

Rib Fracture Stabilization in Patients Sustaining Blunt Chest Injury

2006 ◽  
Vol 72 (4) ◽  
pp. 307-309 ◽  
Author(s):  
Ram Nirula ◽  
Brian Allen ◽  
Ralph Layman ◽  
Mark E. Falimirski ◽  
Lewis B. Somberg
Keyword(s):  
Hospital Length ◽  
Rib Fracture ◽  
Hospital Length Of Stay ◽  
Trauma Patients ◽  
Chest Injuries ◽  
Fracture Stabilization ◽  
Matched Case ◽  
The Impact ◽  
Control Study

Conservative management for the majority of patients with severe chest injuries has produced a reduction in mortality, complications, and hospital length of stay. More recently, operative stabilization of rib fractures has been used with the implication of improved outcome. We assessed the impact of operative rib fracture stabilization on outcome among trauma patients. A matched case-control study of patients undergoing operative rib fracture stabilization was performed. Thirty patients undergoing rib stabilization were matched with 30 controls. Length of intensive care unit (controls, 14.1 ± 2.7 vs cases, 12.1 ± 1.2, P = 0.51) and total hospital (controls, 21.1 ± 3.9 vs cases, 18.8 ± 1.8, P = 0.59) stay were similar for both groups. There was a trend toward fewer total ventilator days for operative patients (6.5 ± 1.3 days vs 11.2 ± 2.6 days, P = 0.12). Ventilator days for operative patients from the time of stabilization was 2.9 ± 0.6 days compared with 9.4 ± 2.7 days in controls (P = 0.02). Rib fracture fixation may reduce ventilator requirements in trauma patients with severe thoracic injuries. Long-term functional outcomes need to be assessed to ascertain the impact of this procedure.

scholarly journals Association between Insurance Status and Hospital Length of Stay following Trauma

2016 ◽  
Vol 82 (3) ◽  
pp. 281-288 ◽  
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.

Influence of Insurance Status on Hospital Length of Stay and Discharge Location in Burn Patients

2018 ◽  
Vol 84 (6) ◽  
pp. 924-929 ◽  
Author(s):  
Rachel M. Nygaard ◽  
Jon R. Gayken ◽  
Frederick W. Endorf
Keyword(s):  
Skilled Nursing Facility ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Insurance Status ◽  
Burn Patients ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Rehabilitation Facility ◽  
Lengths Of Stay ◽  
Discharge Location

Insurance status affects many aspects of healthcare in America, from access to delivery to outcomes. Our goal in this study was to determine whether different subtypes of insurance status affected hospital lengths of stay (LOS) and/or the location to which patients were discharged. The National Burn Repository was used to examine a total of 119,509 burn patients. Patients with noncommercial insurance (NONCOM) have increased LOS and are more likely to be discharged to a nonhome location, compared with no insurance or other insurance subtypes. Patients with no insurance have similar injury characteristics and comorbidities as patients with NONCOM, but have a shorter LOS and are more likely to be discharged home rather than to a skilled nursing facility or rehabilitation facility.

Outcomes of the Maryland Person-Centered Hospital Discharge Program: A Pilot Targeting Decreasing Long-Term Care Use and Hospital Readmissions

2015 ◽  
Vol 16 (1) ◽  
pp. 48-58 ◽  
Author(s):  
Allison Payne Carew ◽  
Barbara Resnick
Keyword(s):  
At Risk ◽  
Nursing Home ◽  
Hospital Discharge ◽  
Long Term Care ◽  
Care Coordinator ◽  
Term Care ◽  
Skilled Nursing ◽  
Care Coordinators

The Person-Centered Hospital Discharge Program (PCHDP) was offered by the Centers for Medicare and Medicaid Services as a way to improve care to Medicare and Medicaid beneficiaries in Maryland. The PCHDP used a care nurse/coordinator to facilitate the successful transition of patients at risk for becoming eligible for Medicaid. The purpose of this study was to examine the outcomes of the PCHDP pilot, explore factors that influenced hospital and long-term care admissions following hospital discharge, and obtain operational data to develop new programs with related objectives. Area Agencies on Aging were provided with a care coordinator who obtained patient data, developed an individualized care plan, and determined visit frequency and length of services. Multivariate analysis of variance was conducted to examine differences between those hospitalized or admitted to a skilled nursing facility during the follow-up period. The sample consisted of 359 at-risk patients, and the mean length of follow-up was approximately two months. Most patients did not go to the emergency room (N = 319, 88%) during the period of follow-up and were not admitted to an acute care setting (N = 301, 84%) or skilled nursing home (N = 322, 86%). Those who were rehospitalized were slightly younger and had more visits from the care coordinator. We anticipate that the care coordinators identified individuals at greatest need for follow-up and support. Future research should explore ways in which these care coordinators can intervene to prevent hospital readmission and long-term nursing home care.

scholarly journals Insurance Status as a Predictor of Hospital Length of Stay in Trauma Patients

2019 ◽  
Vol 85 (1) ◽  
pp. 50-52
Author(s):  
Jessica K. Friedman ◽  
David Swift ◽  
Alison A. Smith ◽  
John Hunt ◽  
Patrick Greiffenstein ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Insurance Status ◽  
Trauma Patients

scholarly journals Pain is vital in resuscitation in trauma

SICOT-J ◽  
2019 ◽  
Vol 5 ◽  
pp. 28
Author(s):  
Theodosios Saranteas ◽  
Andreas Kostroglou ◽  
Dimitrios Anagnostopoulos ◽  
Dimitrios Giannoulis ◽  
Pantelis Vasiliou ◽  
...  
Keyword(s):  
Vital Sign ◽  
Pain Treatment ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Trauma Patients ◽  
Emergency Setting ◽  
Short And Long Term ◽  
Early Healing

Implementation of the ATLS algorithm has remarkably improved the resuscitation of trauma patients and has significantly contributed to the systematic management of multi-trauma patients. However, pain remains the most prevalent complaint in trauma patients, and can induce severe complications, further deterioration of health, and death of the patient. Providing appropriate and timely pain management to these patients prompts early healing, reduces stress response, shortens hospital Length of Stay (LOS), diminishes chronic pain, and ultimately reduces morbidity and mortality. Pain has been proposed to be evaluated as the fifth vital sign and be recorded in the vital sign charts in order to emphasize the importance of pain on short- and long-term outcomes of the patients. However, although the quality of pain treatment seems to be improving we believe that pain has been underestimated in trauma. This article aims to provide evidence for the importance of pain in trauma, to support its management in the emergency setting and the acute phase of patients’ resuscitation, and to emphasize on the necessity to introduce the letter P (pain) in the ATLS alphabet.

Patterns and Effects of Admission Hyperglycemia And Inflammatory Response in Trauma Patients: A Prospective Study

2020 ◽  
Author(s):  
Ayman El-Menyar ◽  
Mohammad Asim ◽  
Fayaz Mir ◽  
Suhail Hakim ◽  
Ahad Kanbar ◽  
...  
Keyword(s):  
Blood Glucose ◽  
Length Of Stay ◽  
Inflammatory Response ◽  
Injury Severity ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Trauma Patients ◽  
Severity Of Injury ◽  
Hs Crp ◽  
Initial Blood

Abstract Background: Hyperglycemia following trauma could be a response to stress. The constellation of the initial hyperglycemia, proinflammatory cytokines and severity of injury among trauma patients is understudied. We aimed to evaluate the patterns and effects of on-admission hyperglycemia and inflammatory response in a level 1 trauma center admissions. Methods: A prospective, observational study was conducted for adult trauma patients who were admitted and tested for on-admission blood glucose, hemoglobin A1c, interleukin (IL)-6 ,Il-18 and hs-CRP. Patients were categorized into 4 groups (non-diabetic normoglycemic, diabetic normoglycemic, diabetic hyperglycemic (DH) and stress-induced hyperglycemic (SIH)). The inflammatory markers were measured on 3 time points (admission, 24 h, and 48 h). Pearson’s correlation test and logistic regression analysis were performed. We hypothesized that higher initial readings of blood glucose and cytokines are associated with severe injuries and worse in-hospital outcomes in trauma patients.Results: During the study period, 250 adult trauma patients were enrolled. Almost 13% of patients presented with hyperglycemia (SIH&DH); of whom 50% had SIH. Compared to the other 3 groups; SIH patients were younger, had significantly higher ISS, higher IL-6 readings, prolonged hospital length of stay and higher mortality. The SIH group had lower Revised Trauma Score (p=0.005), lower Trauma Injury Severity Score (p=0.01) and lower GCS (p=0.001). IL-18 and hs-CRP were comparable among the study groups. Compared to the normoglycemia groups, patients with hyperglycemia had elevated high- sensitive troponin T (p=0.001) and required more blood transfusion (p=0.03). Patients with hyperglycemia had 3-times higher in-hospital mortality than the normoglycemia groups (p=0.02). A significant correlation was identified between initial blood glucose and serum lactate, IL-6, ISS and hospital length of stay. IL-6 correlated well with ISS (r=0.40, p=0.001). On- admission blood glucose had age-sex-GCS adjusted odd ratio 1.20(95% CI 1.06-1.33, p=0.003) for severe injury (ISS≥16).Conclusions: On-admission hyperglycemia is associated with a significant severer injury than normoglycemia patients. Initial blood glucose correlates with serum IL-6 which indicates a potential role of the systemic inflammatory response in the disease pathogenesis among the injured patients. On-admission glucose level could be a useful marker of injury severity, triage and risk assessment in trauma patients.This study was registered at the ClinicalTrials.gov (Identifier: NCT02999386), retrospectively Registered on December 21, 2016 https://clinicaltrials.gov/ct2/show/NCT02999386.

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