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Insurance status is a predictor of failure to rescue in trauma patients at both safety net and non-safety net hospitals.
J Trauma Acute Care Surg. 2013 Oct; 75(4):728-33.JT

Abstract

BACKGROUND

Disparities in outcomes for uninsured trauma patients have been well documented. This study investigates whether failure to rescue (FTR) is a driver of mortality disparities after injury and whether patients treated at hospitals with a large volume of uninsured patients are more likely to die after complication.

METHODS

A retrospective cohort study that analyzed patient records included in the National Trauma Data Bank from years 2008 to 2010 was performed. Hierarchical logistic regression was used to examine the probability that insurance type would be associated with complications, FTR, and in-hospital mortality while controlling for injury severity, mechanism of trauma, age, sex, race, comorbidities, head injury, hypotension, and hospital clustering. Additional regression models that stratified insurance subgroups and hospital subgroups were also performed.

RESULTS

The uninsured patients had the lowest likelihood of developing a complication, and publicly insured patients were most likely to develop a complication compared with privately insured patients (uninsured odds ratio [OR], 0.86; government OR, 1.44). Despite having a lower risk of complication, the uninsured group was significantly more likely to experience FTR than publicly or privately insured patients (OR, 1.34). There was no significant difference in the FTR outcome between private and publicly insured patients. Both the uninsured and publicly insured patients were significantly more likely to die in the hospital than privately insured patients (uninsured OR, 1.26l; government OR, 1.17). There were no differences in complications, FTR, or mortality between safety net and non-safety net hospitals.

CONCLUSION

The uninsured patients are more likely to experience FTR than the privately insured patients. Resources should be focused on this patient population to prevent complications and to study the reasons for higher mortality in these patients after they experience a complication.

LEVEL OF EVIDENCE

Prognostic study, level III.

Authors+Show Affiliations

From the Division of Trauma and Critical Care, Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee.No affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

24064890

Citation

Bell, Teresa M., and Ben L. Zarzaur. "Insurance Status Is a Predictor of Failure to Rescue in Trauma Patients at Both Safety Net and Non-safety Net Hospitals." The Journal of Trauma and Acute Care Surgery, vol. 75, no. 4, 2013, pp. 728-33.
Bell TM, Zarzaur BL. Insurance status is a predictor of failure to rescue in trauma patients at both safety net and non-safety net hospitals. J Trauma Acute Care Surg. 2013;75(4):728-33.
Bell, T. M., & Zarzaur, B. L. (2013). Insurance status is a predictor of failure to rescue in trauma patients at both safety net and non-safety net hospitals. The Journal of Trauma and Acute Care Surgery, 75(4), 728-33. https://doi.org/10.1097/TA.0b013e3182a53aaa
Bell TM, Zarzaur BL. Insurance Status Is a Predictor of Failure to Rescue in Trauma Patients at Both Safety Net and Non-safety Net Hospitals. J Trauma Acute Care Surg. 2013;75(4):728-33. PubMed PMID: 24064890.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Insurance status is a predictor of failure to rescue in trauma patients at both safety net and non-safety net hospitals. AU - Bell,Teresa M, AU - Zarzaur,Ben L, PY - 2013/9/26/entrez PY - 2013/9/26/pubmed PY - 2013/12/16/medline SP - 728 EP - 33 JF - The journal of trauma and acute care surgery JO - J Trauma Acute Care Surg VL - 75 IS - 4 N2 - BACKGROUND: Disparities in outcomes for uninsured trauma patients have been well documented. This study investigates whether failure to rescue (FTR) is a driver of mortality disparities after injury and whether patients treated at hospitals with a large volume of uninsured patients are more likely to die after complication. METHODS: A retrospective cohort study that analyzed patient records included in the National Trauma Data Bank from years 2008 to 2010 was performed. Hierarchical logistic regression was used to examine the probability that insurance type would be associated with complications, FTR, and in-hospital mortality while controlling for injury severity, mechanism of trauma, age, sex, race, comorbidities, head injury, hypotension, and hospital clustering. Additional regression models that stratified insurance subgroups and hospital subgroups were also performed. RESULTS: The uninsured patients had the lowest likelihood of developing a complication, and publicly insured patients were most likely to develop a complication compared with privately insured patients (uninsured odds ratio [OR], 0.86; government OR, 1.44). Despite having a lower risk of complication, the uninsured group was significantly more likely to experience FTR than publicly or privately insured patients (OR, 1.34). There was no significant difference in the FTR outcome between private and publicly insured patients. Both the uninsured and publicly insured patients were significantly more likely to die in the hospital than privately insured patients (uninsured OR, 1.26l; government OR, 1.17). There were no differences in complications, FTR, or mortality between safety net and non-safety net hospitals. CONCLUSION: The uninsured patients are more likely to experience FTR than the privately insured patients. Resources should be focused on this patient population to prevent complications and to study the reasons for higher mortality in these patients after they experience a complication. LEVEL OF EVIDENCE: Prognostic study, level III. SN - 2163-0763 UR - https://www.unboundmedicine.com/medline/citation/24064890/Insurance_status_is_a_predictor_of_failure_to_rescue_in_trauma_patients_at_both_safety_net_and_non_safety_net_hospitals_ L2 - https://doi.org/10.1097/TA.0b013e3182a53aaa DB - PRIME DP - Unbound Medicine ER -