Association between insurance status and <scp>in‐hospital</scp> outcomes in patients with <scp>out‐of‐hospital</scp> ventricular fibrillation arrest

Pancholy, Samir; Patel, Gaurav; Patel, Dhara; Patel, Neil; Pancholy, Shivam A; Patel, Purveshkumar; Thomas-Hemak, Linda; Patel, Tejas; Callans, David J.

doi:10.1002/clc.23564

Cited by 2 publications

(1 citation statement)

References 9 publications

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“…We also found a slight decline in the survival trend in both LBH and HBH during the study period in contrast with demonstrated improvement in IHCA survival outcomes over the last 2 decades (23, 24, 27). Lack of health insurance and underinsurance has been linked to higher in-hospital mortality in cardiac arrest patients (8, 30, 31). We only evaluated IHCA patients with Medicaid or no health insurance categorized by safety-net burden across U.S. hospitals, which likely explains the lower survival rates in both LBH and HBH compared with the general population.…”

Section: Discussionmentioning

confidence: 99%

Impact of Hospital Safety-Net Burden on Outcomes of In-Hospital Cardiac Arrest in the United States

Olanipekun

Abe

Chris-Olaiya

et al. 2023

Critical Care Explorations

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IMPORTANCE: High safety-net burden hospitals (HBHs) treating large numbers of uninsured or Medicaid-insured patients have generally been linked to worse clinical outcomes. However, limited data exist on the impact of the hospitals’ safety-net burden on in-hospital cardiac arrest (IHCA) outcomes in the United States. OBJECTIVES: To compare the differences in survival to discharge, routine discharge home, and healthcare resource utilization between patients at HBH with those treated at low safety-net burden hospital (LBH). DESIGN, SETTING, AND PARTICIPANTS: Retrospective cohort study across hospitals in the United States: Hospitalized patients greater than or equal to 18 years that underwent cardiopulmonary resuscitation (CPR) between 2008 and 2018 identified from the Nationwide Inpatient Database. Data analysis was conducted in January 2022. EXPOSURE: IHCA. MAIN OUTCOMES AND MEASURES: The primary outcome is survival to hospital discharge. Other outcomes are routine discharge home among survivors, length of hospital stay, and total hospitalization cost RESULTS: From 2008 to 2018, an estimated 555,016 patients were hospitalized with IHCA, of which 19.2% occurred at LBH and 55.2% at HBH. Compared with LBH, patients at HBH were younger (62 ± 20 yr vs 67 ± 17 yr) and predominantly in the lowest median household income (< 25th percentile). In multivariate analysis, HBH was associated with lower chances of survival to hospital discharge (adjusted odds ratio [aOR], 0.88; 95% CI, 0.85–0.96) and lower odds of routine discharge (aOR, 0.6; 95% CI, 0.47–0.75), compared with LBH. In addition, IHCA patients at publicly owned hospitals and those with medium and large hospital bed size were less likely to survive to hospital discharge, while patients with median household income greater than 25th percentile had better odds of hospital survival. CONCLUSIONS AND RELEVANCE: Our study suggests that patients who experience IHCA at HBH may have lower rates and odds of in-hospital survival and are less likely to be routinely discharged home after CPR. Median household income and hospital-level characteristics appear to contribute to survival.

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Section: Discussionmentioning

confidence: 99%

Impact of Hospital Safety-Net Burden on Outcomes of In-Hospital Cardiac Arrest in the United States

Olanipekun

Abe

Chris-Olaiya

et al. 2023

Critical Care Explorations

View full text Add to dashboard Cite

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Patient and Hospital Characteristics Associated with Admission Among Patients With Minor Isolated Extremity Firearm Injuries: A Propensity-Matched Analysis

Thomas,

Royan,

Nathens

et al. 2024

Annals of Surgery Open

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Objective: To quantify the association between insurance and hospital admission following minor isolated extremity firearm injury. Background: The association between insurance and injury admission has not been examined. Methods: This was an observational retrospective cohort study of minor isolated extremity firearm injury captured in the Healthcare Cost and Utilization Project State Inpatient and Emergency Department Databases in 6 states (New York, Arkansas, Wisconsin, Massachusetts, Florida, and Maryland) from 2016 to 2017 among patients aged 16 years or older. The primary exposure was insurance. Admitted patients were propensity score matched to nonadmitted patients on age, extremity Abbreviated Injury Score, and Elixhauser Comorbidity Index with exact matching within hospital to adjust for selection bias. A general estimating equation logistic regression estimated the association between insurance and odds of admission in the matched cohort while controlling for sex, race, injury intent, injury type, hospital profit type, and trauma center designation with observations clustered by propensity score-matched pairs within hospital. Results: A total of 8151 patients presented to hospital with a minor isolated extremity firearm injury between 2016 and 2017 in 6 states. Patients were 88.0% male, 56.6% Black, and 71.7% aged 16 to 36 years old, and 22.1% were admitted. A total of 2090 patients were matched on propensity for admission. Privately insured matched patients had 1.70 higher adjusted odds of admission and 95% confidence interval of 1.30 to 2.22, compared with uninsured after adjusting for patient and hospital characteristics. Conclusions: Insurance was associated with hospital admission for minor isolated extremity firearm injury.

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Association between insurance status and in‐hospital outcomes in patients with out‐of‐hospital ventricular fibrillation arrest

Cited by 2 publications

References 9 publications

Impact of Hospital Safety-Net Burden on Outcomes of In-Hospital Cardiac Arrest in the United States

Impact of Hospital Safety-Net Burden on Outcomes of In-Hospital Cardiac Arrest in the United States

Patient and Hospital Characteristics Associated with Admission Among Patients With Minor Isolated Extremity Firearm Injuries: A Propensity-Matched Analysis

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