Tags

Type your tag names separated by a space and hit enter

Insurance and racial differences in long-term acute care utilization after critical illness.
Crit Care Med. 2012 Apr; 40(4):1143-9.CC

Abstract

OBJECTIVES

To determine whether insurance coverage and race are associated with long-term acute care hospital utilization in critically ill patients requiring mechanical ventilation.

DESIGN

Retrospective cohort study.

SETTING

Nonfederal Pennsylvania hospital discharges from 2004 to 2006.

PATIENTS

Eligible patients were aged 18 yrs or older, of white or black race, and underwent mechanical ventilation in an intensive care unit during their hospital stay.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

We used multivariable logistic regression with hospital-level random effects to determine the independent association between discharge to long-term acute care hospital, insurance status, and race after appropriate controls, including a chart-based measure of severity of illness. The primary outcome measure was discharge to long-term acute care hospital. Of 66,233 eligible patients, 84.7% were white and 15.3% were black. More white patients than black patients had commercial insurance (23.4% vs. 14.9%) compared to Medicaid (10.6% vs. 29.7%) or no insurance (1.3% vs. 2.2%). Long-term acute care hospital transfer occurred in 5.0% of patients. On multivariable analysis in patients aged younger than 65 yrs, black patients were significantly less likely to undergo long-term acute care hospital transfer (odds ratio, 0.71; p = .003), as were patients with Medicaid vs. commercial insurance (odds ratio, 0.17; p < .001). Analyzing race and insurance together and accounting for hospital-level effects, patients with Medicaid were still less likely to undergo long-term acute care hospital transfer (odds ratio, 0.18; p < .001), but race effects were no longer present (odds ratio, 1.06; p = .615). No significant race effects were seen in the Medicare-eligible population aged 65 yrs or older (odds ratio for transfer to long-term acute care hospital, 0.93; p = .359).

CONCLUSIONS

Differences in long-term acute care hospital utilization after critical illness appear driven by insurance status and hospital-level effects. Racial variation in long-term acute care hospital use is not seen after controlling for insurance status and is not seen in a group with uniform insurance coverage. Differential access to postacute care may be minimized by expanding commercial or Medicare insurance availability and standardizing long-term acute care admission criteria across hospitals.

Authors+Show Affiliations

Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, PA, USA. meghan.lane-fall@uphs.upenn.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

22020247

Citation

Lane-Fall, Meghan B., et al. "Insurance and Racial Differences in Long-term Acute Care Utilization After Critical Illness." Critical Care Medicine, vol. 40, no. 4, 2012, pp. 1143-9.
Lane-Fall MB, Iwashyna TJ, Cooke CR, et al. Insurance and racial differences in long-term acute care utilization after critical illness. Crit Care Med. 2012;40(4):1143-9.
Lane-Fall, M. B., Iwashyna, T. J., Cooke, C. R., Benson, N. M., & Kahn, J. M. (2012). Insurance and racial differences in long-term acute care utilization after critical illness. Critical Care Medicine, 40(4), 1143-9. https://doi.org/10.1097/CCM.0b013e318237706b
Lane-Fall MB, et al. Insurance and Racial Differences in Long-term Acute Care Utilization After Critical Illness. Crit Care Med. 2012;40(4):1143-9. PubMed PMID: 22020247.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Insurance and racial differences in long-term acute care utilization after critical illness. AU - Lane-Fall,Meghan B, AU - Iwashyna,Theodore J, AU - Cooke,Colin R, AU - Benson,Nicole M, AU - Kahn,Jeremy M, PY - 2011/10/25/entrez PY - 2011/10/25/pubmed PY - 2012/5/9/medline SP - 1143 EP - 9 JF - Critical care medicine JO - Crit Care Med VL - 40 IS - 4 N2 - OBJECTIVES: To determine whether insurance coverage and race are associated with long-term acute care hospital utilization in critically ill patients requiring mechanical ventilation. DESIGN: Retrospective cohort study. SETTING: Nonfederal Pennsylvania hospital discharges from 2004 to 2006. PATIENTS: Eligible patients were aged 18 yrs or older, of white or black race, and underwent mechanical ventilation in an intensive care unit during their hospital stay. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We used multivariable logistic regression with hospital-level random effects to determine the independent association between discharge to long-term acute care hospital, insurance status, and race after appropriate controls, including a chart-based measure of severity of illness. The primary outcome measure was discharge to long-term acute care hospital. Of 66,233 eligible patients, 84.7% were white and 15.3% were black. More white patients than black patients had commercial insurance (23.4% vs. 14.9%) compared to Medicaid (10.6% vs. 29.7%) or no insurance (1.3% vs. 2.2%). Long-term acute care hospital transfer occurred in 5.0% of patients. On multivariable analysis in patients aged younger than 65 yrs, black patients were significantly less likely to undergo long-term acute care hospital transfer (odds ratio, 0.71; p = .003), as were patients with Medicaid vs. commercial insurance (odds ratio, 0.17; p < .001). Analyzing race and insurance together and accounting for hospital-level effects, patients with Medicaid were still less likely to undergo long-term acute care hospital transfer (odds ratio, 0.18; p < .001), but race effects were no longer present (odds ratio, 1.06; p = .615). No significant race effects were seen in the Medicare-eligible population aged 65 yrs or older (odds ratio for transfer to long-term acute care hospital, 0.93; p = .359). CONCLUSIONS: Differences in long-term acute care hospital utilization after critical illness appear driven by insurance status and hospital-level effects. Racial variation in long-term acute care hospital use is not seen after controlling for insurance status and is not seen in a group with uniform insurance coverage. Differential access to postacute care may be minimized by expanding commercial or Medicare insurance availability and standardizing long-term acute care admission criteria across hospitals. SN - 1530-0293 UR - https://www.unboundmedicine.com/medline/citation/22020247/Insurance_and_racial_differences_in_long_term_acute_care_utilization_after_critical_illness_ L2 - https://dx.doi.org/10.1097/CCM.0b013e318237706b DB - PRIME DP - Unbound Medicine ER -