The effect of discharge destination and primary insurance provider on hospital discharge delays among patients with traumatic brain injury: a multicenter study of 1,543 patients

Abstract

BackgroundHospital length of stay (HLOS) is a commonly used measure of hospital quality and is influenced by clinical and non-clinical factors. To reduce HLOS, it is key to identify factors placing patients at increased risk of lengthy HLOS and discharge delays.MethodsThis was a retrospective cohort study of patients age ≥ 18 admitted to four level 1 trauma centers between 1/1/2015 and 3/31/2018 with traumatic brain injury (TBI). The primary outcome was discharge delay, defined as discharge ≥24 h after case management notes indicated the patient was ready for discharge. The independent variables of interest were primary insurance provider and discharge destination. Chi-square, Fisher exact, and unadjusted and adjusted logistic regression analyses were used to assess associations between discharge delay and the two primary independent variables, as well as other patient demographic and clinical characteristics. Complications developing during the delay period were also examined.ResultsA total of 1543 patients with TBI were included. The median age was 61 years, and the median HLOS was 5 days. Approximately half of patients were discharged home (54%). The most common insurance providers were Medicare (35%) and commercial/private (35%). Two-hundred ten (14%) patients experienced a discharge delay. The median delay period was 3 days, and the most common reasons for delay were insurance authorization (52%) and lack of accepting bed (41%). Compared to being discharged home, patients discharged to a skilled nursing facility (adjusted odds ratio (AOR) = 10.35) or intermediate care facility (AOR = 10.64) had the highest odds of discharge delay. Compared to Medicare patients, uninsured/self-pay patients (AOR = 2.98) and those with Medicaid (AOR = 2.83) or commercial/private insurance (AOR = 2.22) had higher odds of delay. Thirty-two patients (15% of those delayed) experienced at least one complication during the delay, some of which were clinically severe.ConclusionsA substantial portion of TBI patients in this study experienced discharge delays, and discharge destination and primary insurance provider were significant drivers of these delays. Evaluation of a facility’s quality of care should consider the specific causes of these delays.

Late-week surgery and discharge to specialty care associated with higher costs and longer lengths of stay after elective lumbar laminectomy

“…Indeed, transfers to SNFs or rehabilitation centers can be delayed by difficulties in coordinating care with insurance companies. 19 There is also evidence to suggest why such delays in patient discharge may be accentuated over the weekend. For instance, reduced hospital weekend staffing, including fewer occupational and physical therapists and social workers, results in poorer access to ancillary services, 20 and similar staffing challenges also exist at the subacute skilled nursing and rehabilitation centers that receive patients.…”

Effect of the COVID-19 pandemic on health insurance coverage among trauma patients: a study of six level I trauma centers

“…Using 3.5 years of prepandemic data from four of the level 1 trauma centers included in this study, we previously found that the most commonly used insurance types among a subgroup of trauma patients were Medicare (35%), commercial/private insurance (35%), and Medicaid (10%), and this group had an uninsured rate of 13%. 12 However, trauma admission volumes have declined during the pandemic, and the types of injuries have shifted, for example, the rates of motor vehicle collisions have decreased because of stay-at-home orders. 13–16 Because insurance status among trauma patients is affected by patient characteristics, such as socioeconomic status, age, and race, 17–19 and shifts in the types of injuries may have altered the demographics of this patient population during the pandemic, it is likely that a corresponding shift in health insurance coverage has also occurred in the trauma patient population.…”

Delay in Hospital Discharge of Trauma Patients: A Prospective Observational Study

“…Payer related issues and insurance provider delays were among the main reasons for delayed discharge in the USA [8,18]. But in the current study, the hospital offered free service to the patients, and hence, payment related issues were not encountered; although the situation might be different in other settings such as in private hospitals.…”

“…There is no standard de nition for delayed hospital discharge in the literature. One study in the USA used insurance Diagnosis Related Group-based time points [8], another study used a 24-hour cut off point to de ne delayed discharge [18]. Both studies acknowledged that discharge delay duration varies between practices and institutes.…”

“…It is to be noted that other factors related to rehabilitation facility arrangements post-discharge were found to be strongly associated with discharge delays in the USA and the UK [5,[8][9][10]18]. Such facilities are not as common in Egypt.…”