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Insurance status and hospital discharge disposition after trauma: inequities in access to postacute care.
J Trauma. 2011 Oct; 71(4):1011-5.JT

Abstract

BACKGROUND

Postacute care is an essential component of medical care aimed at returning trauma patients to their preinjury functional status. Rehabilitation services, skilled nursing facilities, and home care all play a role in facilitating the healing process. Access to such care may be limited based on insurance status, leaving the uninsured with limited resources to reach full recovery. We hypothesized that access to specialized postacute care is less available to patients who lack health insurance.

METHODS

A retrospective cohort of trauma patients in the National Trauma Databank from 2002 to 2006 was assessed to determine whether insurance status was a predictor of discharge to a specialized postacute care facility (rehabilitation, skilled nursing facilities, and home health). Using multivariate logistic regression, we assessed the likelihood of discharge to such facilities on the basis of insurance status, controlling for patient demographics and injury severity.

RESULTS

Adjusting for variation in age, race/ethicity, gender, and injury type and severity, uninsured patients had the lowest odds of being discharged to a skilled nursing facility (odds ratio [OR], 0.76; 95% confidence interval [CI] 0.73-0.80; p<0.001), home health (OR, 0.51; 95% CI 0.49-0.53; p<0.001), and rehabilitation (OR, 0.45; 95% CI 0.44-0.46; p<0.001). Uninsured patients had the highest odds, however, of being discharged directly home (OR, 1.32; 95% CI 1.30-1.34; p<0.001).

CONCLUSION

Insurance status is an important predictor of hospital disposition and access to specialized posthospital care. Uninsured patients are less likely to have access to the full range of medical care available to ensure complete recovery from traumatic injuries.

Authors+Show Affiliations

Department of Health Policy and Management, Center for Surgery and Public Health, Harvard School of Public Health, and Division of Burn, Trauma, and Surgical Critical Care, Department of Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.No affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

21399544

Citation

Sacks, Greg D., et al. "Insurance Status and Hospital Discharge Disposition After Trauma: Inequities in Access to Postacute Care." The Journal of Trauma, vol. 71, no. 4, 2011, pp. 1011-5.
Sacks GD, Hill C, Rogers SO. Insurance status and hospital discharge disposition after trauma: inequities in access to postacute care. J Trauma. 2011;71(4):1011-5.
Sacks, G. D., Hill, C., & Rogers, S. O. (2011). Insurance status and hospital discharge disposition after trauma: inequities in access to postacute care. The Journal of Trauma, 71(4), 1011-5. https://doi.org/10.1097/TA.0b013e3182092c27
Sacks GD, Hill C, Rogers SO. Insurance Status and Hospital Discharge Disposition After Trauma: Inequities in Access to Postacute Care. J Trauma. 2011;71(4):1011-5. PubMed PMID: 21399544.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Insurance status and hospital discharge disposition after trauma: inequities in access to postacute care. AU - Sacks,Greg D, AU - Hill,Caterina, AU - Rogers,Selwyn O,Jr PY - 2011/3/15/entrez PY - 2011/3/15/pubmed PY - 2011/12/13/medline SP - 1011 EP - 5 JF - The Journal of trauma JO - J Trauma VL - 71 IS - 4 N2 - BACKGROUND: Postacute care is an essential component of medical care aimed at returning trauma patients to their preinjury functional status. Rehabilitation services, skilled nursing facilities, and home care all play a role in facilitating the healing process. Access to such care may be limited based on insurance status, leaving the uninsured with limited resources to reach full recovery. We hypothesized that access to specialized postacute care is less available to patients who lack health insurance. METHODS: A retrospective cohort of trauma patients in the National Trauma Databank from 2002 to 2006 was assessed to determine whether insurance status was a predictor of discharge to a specialized postacute care facility (rehabilitation, skilled nursing facilities, and home health). Using multivariate logistic regression, we assessed the likelihood of discharge to such facilities on the basis of insurance status, controlling for patient demographics and injury severity. RESULTS: Adjusting for variation in age, race/ethicity, gender, and injury type and severity, uninsured patients had the lowest odds of being discharged to a skilled nursing facility (odds ratio [OR], 0.76; 95% confidence interval [CI] 0.73-0.80; p<0.001), home health (OR, 0.51; 95% CI 0.49-0.53; p<0.001), and rehabilitation (OR, 0.45; 95% CI 0.44-0.46; p<0.001). Uninsured patients had the highest odds, however, of being discharged directly home (OR, 1.32; 95% CI 1.30-1.34; p<0.001). CONCLUSION: Insurance status is an important predictor of hospital disposition and access to specialized posthospital care. Uninsured patients are less likely to have access to the full range of medical care available to ensure complete recovery from traumatic injuries. SN - 1529-8809 UR - https://www.unboundmedicine.com/medline/citation/21399544/Insurance_status_and_hospital_discharge_disposition_after_trauma:_inequities_in_access_to_postacute_care_ L2 - https://doi.org/10.1097/TA.0b013e3182092c27 DB - PRIME DP - Unbound Medicine ER -