Insurance status is a potent predictor of outcomes in both blunt and penetrating trauma

Greene, Wendy R.; Oyetunji, Tolulope A.; Bowers, Umar; Haider, Adil H.; Mellman, Thomas A.; Cornwell, Edward E.; Siram, Suryanarayana M.; Chang, David C.

doi:10.1016/j.amjsurg.2009.11.005

Cited by 140 publications

(122 citation statements)

References 10 publications

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“…This finding was consistent among studies of the National Trauma Data Bank (NTDB), in regional studies, and in single-institution studies. [20][21][22]28,29 The finding also held across studies of both adults and pediatric patients, 15,23 independent of injury type. 28 Vettukattil et al suggest that patients treated at safety-net hospitals do not suffer an increased burden of mortality, despite the fact that they treat a higher burden of uninsured patients.…”

Section: Disparities By Insurance Statussupporting

confidence: 50%

“…Of fourteen studies that assessed the impact of insurance status on trauma outcomes, thirteen 12,14,15,[20][21][22][23][24][25][26][27][28][29] conclude that uninsured trauma patients had higher mortality rates than insured patients while one study 8 found they had worse long-term functional outcomes. This finding was consistent among studies of the National Trauma Data Bank (NTDB), in regional studies, and in single-institution studies.…”

Section: Disparities By Insurance Statusmentioning

confidence: 99%

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Disparities in trauma care and outcomes in the United States: A systematic review and meta-analysis

Haider

Weygandt

Bentley

et al. 2013

Journal of Trauma and Acute Care Surgery

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157

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Section: Disparities By Insurance Statussupporting

confidence: 50%

Section: Disparities By Insurance Statusmentioning

confidence: 99%

Disparities in trauma care and outcomes in the United States: A systematic review and meta-analysis

Haider

Weygandt

Bentley

et al. 2013

Journal of Trauma and Acute Care Surgery

Self Cite

157

View full text Add to dashboard Cite

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“…10,11 There is also concern that for-profi t hospitals have an incentive to maximize fi nancial margins from patient care by limiting therapies or decreasing length of stay for uninsured patients.…”

Section: Insur a Nce A Nd Hospi Ta L L Eng T H O F S Taymentioning

confidence: 99%

“…9 There are some data suggesting that lack of insurance is associated with higher mortality risk once hospitalized. 10,11 There is also concern that for-profi t hospitals have an incentive to maximize fi nancial margins from patient care by limiting therapies or decreasing length of stay for uninsured patients. 12,13 This hypothesis is supported by data that show the mean uninsured stay is $1,600 less expensive and shorter (4.0 vs 4.6 days) than a typical hospital stay.…”

Section: -5 Insur a Nce A Nd Hospi Ta L L Eng T H O F S Taymentioning

confidence: 99%

Impact of Insurance and Hospital Ownership on Hospital Length of Stay Among Patients With Ambulatory Care-Sensitive Conditions

Mainous¹,

Díaz²,

Everett³

et al. 2011

The Annals of Family Medicine

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PURPOSE Some studies suggest proprietary (for-profi t) hospitals are maximizing fi nancial margins from patient care by limiting therapies or decreasing length of stay for uninsured patients. This study examines the role of insurance related to length of stay once the patient is in the hospital and risk for mortality, particularly in a for-profi t environment. METHODSWe undertook an analysis of hospitalizations in the National Hospital Discharge Survey (NHDS) of the 5-year period of 2003 to 2007 for patients aged 18 to 64 years (unweighted n = 849,866; weighted n = 90 million). The analysis included those who were hospitalized with both ambulatory care-sensitive conditions (ACSCs), hospitalizations considered to be preventable, and non-ACSCs. We analyzed the transformed mean length of stay between individuals who had Medicaid or all other insurance types while hospitalized and those who were hospitalized without insurance. This analysis was stratifi ed by hospital ownership. We also examined the relationship between in-hospital mortality and insurance status.RESULTS After controlling for comorbidities; age, sex, and race/ethnicity; and hospitalizations with either an ACSC or non-ACSC diagnosis, patients without insurance tended to have a signifi cantly shorter length of stay. Across all hospital types, the mean length of stay for ACSCs was signifi cantly shorter for individuals without insurance (2.77 days) than for those with either private insurance (2.89 days, P = .04) or Medicaid (3.19, P <.01). Among hospitalizations for ACSCs, inhospital mortality rate for individuals with either private insurance or Medicaid was not signifi cantly different from the mortality rate for those without insurance.CONCLUSIONS Patients without insurance have shorter lengths of stay for both ACSCs and non-ACSCs. Future research should examine whether patients without insurance are being discharged prematurely. INTRODUCTIONT he problem of health care access is one that continues to vex the United States. Recent estimates suggest that in 2009, 46 million US residents younger than 65 years (17.5%) were uninsured.1 Insurance is an indicator of access to care and is associated with getting timely care for conditions for which appropriate access can make a major difference. Past studies show that patients who do not have health insurance are less likely than those with health insurance to be seen by a physician in ambulatory care for acute conditions.2 Health care access, particularly in an ambulatory setting, for such conditions as pneumonia and asthma is important because lack of access leads to increased emergency department use, as well as what could be termed preventable hospitalizations. 490 INSUR A NCE A ND HOSPI TA L L ENG T H O F S TAYAlthough the recent passage of the Patient Protection and Affordable Care Act provides health insurance for many more Americans, it is unclear whether other factors affecting the cost of health insurance will actually increase the number of uninsured resulting from the increasing cost o...

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“…This may be due to economic pressures of family leading to higher rates of employment within this age group. In addition, compared with other developed countries, the insurance status and socioeconomic standards are less advanced in developing countries (12,13). Therefore, a number of citizens may work in poor working environments, where the risks of abdominal injuries are higher.…”

Section: Discussionmentioning

confidence: 99%

Epidemiology and management of splenic injury: An analysis of a Chinese military registry

Yong

Qiu

Yang

et al. 2017

Experimental and Therapeutic Medicine

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Abstract. In China, there have been few meta-analyses of the epidemiology and management of splenic injury. Due to the success of Chinese military hospitals in the domestic treatment of splenic injury, the present study conducted a systematic review of such cases, identifying a high occurrence rate of splenic trauma, as well as a number of strategies of managing splenic injury in China. Data were collected from sixteen Chinese military hospitals between July 2000 and March 2009, and retrospectively reviewed. It was observed that between July 2000 and March 2009 a total of 7,807 patients (84.32% male and 15.68% female) with splenic injury were admitted to hospital. The mean duration of hospital stay was 17.9±18.6 days and the gender distribution of splenic injury over the successive years did not differ significantly (P>0.05, c= 0.034). However, there was a significant difference in the gender distribution of splenic injury patients in different months (P<0.05, c=0.063). In addition, admission numbers for splenic injury were highest in September, October and November. It was also found that splenic injury may occur at all ages, though patients of working age (20-50 years), which comprises 85.59% of patients, the highest proportion of all recorded cases. Associations between mortality rate and each management strategy were as follows: Operative management, 0.11% and non-operative management, 0.15%. Furthermore, multivariate analysis demonstrated that transfusion, New Injury Severity Score and management strategies were all correlated with mortality rate. Thus, despite a lack of data for inpatients from civilian hospitals, the present study has, in part, identified the epidemiology and management strategies of splenic injury in China. These findings may supplement those from previous analyses of splenic injury in other countries and regions.

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Insurance status is a potent predictor of outcomes in both blunt and penetrating trauma

Cited by 140 publications

References 10 publications

Disparities in trauma care and outcomes in the United States: A systematic review and meta-analysis

Disparities in trauma care and outcomes in the United States: A systematic review and meta-analysis

Impact of Insurance and Hospital Ownership on Hospital Length of Stay Among Patients With Ambulatory Care-Sensitive Conditions

Epidemiology and management of splenic injury: An analysis of a Chinese military registry

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