Association Between Insurance and Transfer of Injured Children from Emergency Departments

Huang, Yaoguo; Kissee, Jamie L.; Dayal, Parul; Wang, Ewen; Marcin, James P.

doi:10.1542/peds.141.1_meetingabstract.489

Cited by 6 publications

(7 citation statements)

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“…Patient‐level confounders included age, gender, race/ethnicity, insurance, severity of illness, and having a complex chronic condition. Insurance was included as a patient‐level and index hospital‐level confounder since there is evidence that insurance may affect transfer and ED choice at each level 3,32 . Derived index hospital variables (e.g., pediatric volume and percent Medicaid) were standardized by subtracting the sample mean and dividing the result by the sample standard deviation to put the variables on a similar scale and to stabilize model estimates.…”

Section: Methodsmentioning

confidence: 99%

Association between emergency department pediatric readiness and transfer of noninjured children in small rural hospitals

Lieng

Marcin

Sigal

et al. 2021

The Journal of Rural Health

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Purpose Pediatric readiness scores may be a useful measure of a hospital's preparedness to care for children. However, there is limited evidence linking these scores with patient outcomes or other metrics, including the need for interfacility transfer. This study aims to determine the association of pediatric readiness scores with the odds of interfacility transfer among a cohort of noninjured children (< 18 years old) presenting to emergency departments (EDs) in small rural hospitals in the state of California. Methods Data from the National Pediatric Readiness Project assessment were linked with the California Office of Statewide Health Planning and Development's ED and inpatient databases to conduct a cross‐sectional study of pediatric interfacility transfers. Hospitals were manually matched between these data sets. Logistic regression was performed with random intercepts for hospital and adjustment for patient‐level confounders. Findings A total of 54 hospitals and 135,388 encounters met the inclusion criteria. EDs with a high pediatric readiness score (>70) had lower adjusted odds of transfer (aOR: 0.55, 95% CI: 0.33–0.93) than EDs with a low pediatric readiness score (≤ 70). The pediatric readiness section with strongest association with transfer was the “policies, procedures, and protocols” section; EDs in the highest quartile had lower odds of transfer than EDs in the lowest quartile (aOR: 0.54, 95% CI: 0.31–0.91). Conclusions Pediatric patients presenting to EDs at small rural hospitals with high pediatric readiness scores may be less likely to be transferred. Additional studies are recommended to investigate other pediatric outcomes in relation to hospital ED pediatric readiness.

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Section: Methodsmentioning

confidence: 99%

Association between emergency department pediatric readiness and transfer of noninjured children in small rural hospitals

Lieng

Marcin

Sigal

et al. 2021

The Journal of Rural Health

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“…Because trauma patients experience different transfer patterns 17,18 and transfer protocols than nontrauma patients, [19][20][21] we determined a priori that analyses would be stratified on the presence (vs absence) of one or more -2021…”

Section: Statistical Analysesmentioning

confidence: 99%

Emergency Department Pediatric Readiness and Potentially Avoidable Transfers

Lieng

Marcin

Dayal

et al. 2021

The Journal of Pediatrics

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Objective To determine the association between potentially avoidable transfers (PATs) and emergency department (ED) pediatric readiness scores and the score's associated components. Study designThis cross-sectional study linked the 2012 National Pediatric Readiness Project assessment with individual encounter data from California's statewide ED and inpatient databases during the years 2011-2013. A probabilistic linkage, followed by deterministic heuristics, linked pretransfer, and post-transfer encounters. Applying previously published definitions, a transferred child was considered a PAT if they were discharged within 1 day from the ED or inpatient care and had no specialized procedures. Analyses were stratified by injured and noninjured children. We compared PATs with necessary transfers using mixed-effects logistic regression models with random intercepts for hospital and adjustment for patient and hospital covariates.Results After linkage, there were 6765 injured children (27% PATs) and 18 836 noninjured children (14% PATs) who presented to 283 hospitals. In unadjusted analyses, a 10-point increase in pediatric readiness was associated with lower odds of PATs in both injured (OR 0.93, 95% CI 0.90-0.96) and noninjured children (OR 0.90, 95% CI 0.88-0.93). In adjusted analyses, a similar association was detected in injured patients (aOR 0.92, 95% CI 0.86-0.98) and was not detected in noninjured patients (aOR 0.94, 95% CI 0.88-1.00). Components associated with decreased PATs included having a nurse pediatric emergency care coordinator and a quality improvement plan.Conclusions Hospital ED pediatric readiness is associated with lower odds of a PAT. Certain pediatric readiness components are modifiable risk factors that EDs could target to reduce PATs.

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“…[10][11][12][13][14][15][16][17] Whether racial and ethnic disparities in IHT contribute to gaps in healthcare access is less well studied. Prior IHT research, 1,3,[18][19][20][21][22][23][24][25][26][27][28][29] including registry-based studies exploring factors associated with IHT, 1,4,24 has suggested influence of non-clinical factors, including race/ethnicity, on transfer practices. The most robust body of evidence derives from the cardiology literature, 3,19,20,23,26 in which minority patients have been shown to be less likely to be transferred to hospitals with revascularization capabilities.…”

Section: Introductionmentioning

confidence: 99%

Identifying Racial/Ethnic Disparities in Interhospital Transfer: an Observational Study

2020

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BACKGROUND: Interhospital transfer (IHT) is often performed to provide patients with specialized care. Racial/ ethnic disparities in IHT have been suggested but are not well-characterized. OBJECTIVE: To evaluate the association between race/ ethnicity and IHT. DESIGN: Cross-sectional analysis of 2016 National Inpatient Sample data. PATIENTS: Patients aged ≥ 18 years old with common medical diagnoses at transfer, including acute myocardial infarction, congestive heart failure, arrhythmia, stroke, sepsis, pneumonia, and gastrointestinal bleed. MAIN MEASURES: We performed a series of logistic regression models to estimate adjusted odds of transfer by race/ethnicity controlling for patient demographics, clinical variables, and hospital characteristics and to identify potential mediators. In secondary analyses, we estimated adjusted odds of transfer among patients at community hospitals (those more likely to transfer patients) and performed subgroup analyses by region and primary medical diagnosis. KEY RESULTS: Of 5,774,175 weighted hospital admissions, 199,015 (4.5%) underwent IHT, including 4.7% of White patients, compared with 3.9% of Black patients and 3.8% of Hispanic patients. Black (OR 0.83, 95% CI 0.78-0.89) and Hispanic (OR 0.81, 95% CI 0.75-0.87) patients had lower crude odds of transfer compared with White patients, but this became non-significant after adjusting for hospital-level characteristics. In secondary analyses among patients hospitalized at community hospitals, Hispanic patients had lower adjusted odds of transfer (aOR 0.89, 95% CI 0.79-0.98). Disparities in IHT by race/ ethnicity varied by region and medical diagnosis. CONCLUSIONS: Black and Hispanic patients had lower odds of IHT, largely explained by a higher likelihood of being hospitalized at urban teaching hospitals. Racial/ ethnic disparities in transfer were demonstrated at community hospitals, in certain geographic regions and among patients with specific diseases.

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Association Between Insurance and Transfer of Injured Children from Emergency Departments

Cited by 6 publications

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Association between emergency department pediatric readiness and transfer of noninjured children in small rural hospitals

Association between emergency department pediatric readiness and transfer of noninjured children in small rural hospitals

Emergency Department Pediatric Readiness and Potentially Avoidable Transfers

Identifying Racial/Ethnic Disparities in Interhospital Transfer: an Observational Study

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