Do Geographic Region, Medicaid Status, and Academic Affiliation Affect Access to Care Among Medicaid and Privately Insured Total Hip Arthroplasty Patients?

Almaguer, Adam M.; Hsu, Alan; Pearson, Jeffrey; McKissack, Haley; Jones, James R.; Naranje, Sameer; Shah, Ashish

doi:10.1016/j.arth.2019.07.030

Cited by 16 publications

(20 citation statements)

References 13 publications

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“…For example, one study elucidated that in 10 different states, 5 of which participated in the Medicaid expansion and 5 which did not, success in making an appointment before total knee arthroplasty (TKA) was significantly higher in patients with private insurance versus Medicaid, and average time to preoperative TKA appointment was reported to be significantly higher in the Medicaid cohort when compared to private insurance. 46 An additional study displayed similar findings in the context of first time shoulder dislocation and time to first orthopaedic clinic appointment. 47 Furthermore, Medicaid patients in states that participated in the expansion had a more difficult time making an appointment than patients in states that did not participate, such as Florida.…”

Section: Discussionmentioning

confidence: 57%

Achilles Injury and Access to Care in South Florida

Boden

Geller

Granger

et al. 2020

Foot & Ankle Specialist

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Introduction. Despite the amount of orthopaedic research evaluating access to care based on insurance status, no study quantifies the effects of insurance status on the care of acute Achilles tendon ruptures. Methods. Using Current Procedural Terminology codes, we identified all patients who underwent surgical management of Achilles tendon rupture between December 31, 2013, and December 31, 2018, and followed-up at either a county hospital–based orthopaedic surgery clinic and/or private university–based clinic. Inclusion criteria included patients who (1) underwent surgical management of an Achilles tendon rupture during this time period and (2) were at least 18 years of age at the time of surgery. A univariate 2-tailed t test was used to compare various groups. Statistical significance was set at P < 0.05. Results. When compared to adequately insured patients (private and Medicare), underinsured patients (uninsured and Medicaid) experienced a significantly greater time from the date of injury to first clinic visit (14.5 days vs 5.2 days, P < .001), first clinic visit to surgery (34.6 days vs 4.8 days, P < .002), injury to surgery date (48.9 days vs 9.8 days, P < .001), initial presentation to when magnetic resonance imaging was obtained (48.1 days vs 1.9 days, P < .002). Conclusions. Disparities in access to care for Achilles tendon ruptures are intimately related to insurance status. Uninsured and Medicaid patients are subject to institutional delays and decreased access to care when compared to patients with private insurance. Levels of Evidence: Level III: Prognostic, retrospective

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Section: Discussionmentioning

confidence: 57%

Achilles Injury and Access to Care in South Florida

Boden

Geller

Granger

et al. 2020

Foot & Ankle Specialist

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“…reported that appointments for THA evaluation were successful 99% of the time with private insurance vs . 72% of the time with Medicaid ( P < 0.001) [ 6 ]. Average time to appointment was also longer for Medicaid compared to private insurance (26 days vs .…”

Section: Resultsmentioning

confidence: 99%

“…Average time to appointment was also longer for Medicaid compared to private insurance (26 days vs . 13 days, P = 0.02) [ 6 ]. Boylan et al .…”

Section: Resultsmentioning

confidence: 99%

Socioeconomic factors affecting outcomes in total knee and hip arthroplasty: a systematic review on healthcare disparities

et al. 2022

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Background Recent studies showed that healthcare disparities exist in use of and outcomes after total joint arthroplasty (TJA). This systematic review was designed to evaluate the currently available evidence regarding the effect socioeconomic factors, like income, insurance type, hospital volume, and geographic location, have on utilization of and outcomes after lower extremity arthroplasty. Methods A comprehensive search of the literature was performed by querying the MEDLINE database using keywords such as, but not limited to, “disparities”, “arthroplasty”, “income”, “insurance”, “outcomes”, and “hospital volume” in all possible combinations. Any study written in English and consisting of level of evidence I-IV published over the last 20 years was considered for inclusion. Quantitative and qualitative analyses were performed on the data. Results A total of 44 studies that met inclusion and quality criteria were included for analysis. Hospital volume is inversely correlated with complication rate after TJA. Insurance type may not be a surrogate for socioeconomic status and, instead, represent an independent prognosticator for outcomes after TJA. Patients in the lower-income brackets may have poorer access to TJA and higher readmission risk but have equivalent outcomes after TJA compared to patients in higher income brackets. Rural patients have higher utilization of TJA compared to urban patients. Conclusion This systematic review shows that insurance type, socioeconomic status, hospital volume, and geographic location can have significant impact on patients’ access to, utilization of, and outcomes after TJA. Level of evidence IV.

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“…Lots of relevant research has consistently identi ed THA as a successful treatment for patients' endstage hip diseases [11]. Over time, the implementation process of DRGs-based payment has developed rapidly and LOS has become one of the most critical manifestations of health policies [12,13]. Even though there has been rapid progress in THA surgery, there is little literature concerning factors that may affect LOS of THA patients.…”

Section: Discussionmentioning

confidence: 99%

Patient Characteristics and Medical Provider Factors Are Associated With Length of Stay in Total Hip Arthroplasty Patients: a Retrospective Chinese Cohort Study

Zeng¹,

Li²,

Yu³

et al. 2020

Preprint

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Background Total hip arthroplasty (THA) is a successful treatment in the improvement of quality of life. Diagnosis-related groups (DRGs) payment has a significant impact on the hospital market in China and length of stay (LOS) is one of its crucial manifestations. Patient characteristics and medical provider factors can affect LOS but the relationship is uncertain. We intent to explore the relationship between patient characteristics and medical provider factors and LOS of primary THA patients. Methods We reviewed the database containing 461 patients who underwent primary THA between January 2014 to January 2019 and regressed the LOS against a variety of perioperative factors. A multivariable linear regression model was performed to assess the difference. Results For parts of patient characteristics, multivariable linear regression analysis revealed that comorbidities, pre-operation albumin < 30 g/L, and pre-operation CRP ≥ 5 mg/L were all significantly associated with LOS (p < 0.05). For parts of medical provider factors, multivariable linear regression analysis revealed that date of surgery, urinary catheter, and incision drainage were all significantly associated with LOS (p < 0.05). Conclusions Patient characteristics and medical provider factors are associated with LOS of THA patients. Evaluation and identification of risk factors are beneficial in patients' education, perioperative discussion and surgery decisions in the different primary THA patient populations.

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Do Geographic Region, Medicaid Status, and Academic Affiliation Affect Access to Care Among Medicaid and Privately Insured Total Hip Arthroplasty Patients?

Cited by 16 publications

References 13 publications

Achilles Injury and Access to Care in South Florida

Achilles Injury and Access to Care in South Florida

Socioeconomic factors affecting outcomes in total knee and hip arthroplasty: a systematic review on healthcare disparities

Patient Characteristics and Medical Provider Factors Are Associated With Length of Stay in Total Hip Arthroplasty Patients: a Retrospective Chinese Cohort Study

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