Association between insurance and transfer of injured children from emergency departments

Yunru Huang, Jamie L. Kissee, Parul Dayal, Nancy Ewen Wang, Ilana S. Sigal, James P Marcin

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

OBJECTIVES: To determine if injured children presenting to nondesignated trauma centers are more or less likely to be transferred relative to being admitted based on insurance status. METHODS: We conducted a cross-sectional study by using the Healthcare Cost and Utilization Project Nationwide Emergency Department Sample. Pediatric trauma patients receiving care in emergency departments (EDs) at nontrauma centers who were either admitted locally or transferred to another hospital were included. We performed logistic regression analysis adjusting for injury severity and other confounders and incorporated nationally representative weights to determine the association between insurance and transfer or admission. RESULTS: Nine thousand four hundred and sixty-one ED pediatric trauma events at 386 nontrauma centers met inclusion criteria. EDs that treated a higher proportion of patients with Medicaid had higher odds of transfer relative to admission (odds ratio [OR]: 1.2 per 10% increase in Medicaid; 95% confidence interval [CI]: 1.1-1.4), resulting in overall higher odds of transfer among patients with Medicaid compared with patients with private insurance (OR: 1.3; 95% CI: 1.0-1.5). A patient's insurance status was not associated with different odds of transfer relative to admission within individual EDs after adjusting for the ED's proportion of patients with Medicaid (Medicaid OR: 1.0; 95% CI: 0.8-1.1). CONCLUSIONS: Injured pediatric patients presenting to nondesignated trauma centers are slightly more likely to be transferred than admitted when the ED treats a higher proportion of Medicaid patients. In this study, ongoing concerns about inequities in the delivery of care among hospitals treating high proportions of children with Medicaid are reinforced.

Original languageEnglish (US)
Article numbere20173640
JournalPediatrics
Volume140
Issue number4
DOIs
StatePublished - Oct 1 2017

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Medicaid
Insurance
Hospital Emergency Service
Odds Ratio
Insurance Coverage
Trauma Centers
Confidence Intervals
Pediatrics
Wounds and Injuries
Patient Transfer
Health Care Costs
Patient Care
Cross-Sectional Studies
Logistic Models
Regression Analysis
Weights and Measures

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Association between insurance and transfer of injured children from emergency departments. / Huang, Yunru; Kissee, Jamie L.; Dayal, Parul; Wang, Nancy Ewen; Sigal, Ilana S.; Marcin, James P.

In: Pediatrics, Vol. 140, No. 4, e20173640, 01.10.2017.

Research output: Contribution to journalArticle

Huang, Yunru ; Kissee, Jamie L. ; Dayal, Parul ; Wang, Nancy Ewen ; Sigal, Ilana S. ; Marcin, James P. / Association between insurance and transfer of injured children from emergency departments. In: Pediatrics. 2017 ; Vol. 140, No. 4.
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abstract = "OBJECTIVES: To determine if injured children presenting to nondesignated trauma centers are more or less likely to be transferred relative to being admitted based on insurance status. METHODS: We conducted a cross-sectional study by using the Healthcare Cost and Utilization Project Nationwide Emergency Department Sample. Pediatric trauma patients receiving care in emergency departments (EDs) at nontrauma centers who were either admitted locally or transferred to another hospital were included. We performed logistic regression analysis adjusting for injury severity and other confounders and incorporated nationally representative weights to determine the association between insurance and transfer or admission. RESULTS: Nine thousand four hundred and sixty-one ED pediatric trauma events at 386 nontrauma centers met inclusion criteria. EDs that treated a higher proportion of patients with Medicaid had higher odds of transfer relative to admission (odds ratio [OR]: 1.2 per 10{\%} increase in Medicaid; 95{\%} confidence interval [CI]: 1.1-1.4), resulting in overall higher odds of transfer among patients with Medicaid compared with patients with private insurance (OR: 1.3; 95{\%} CI: 1.0-1.5). A patient's insurance status was not associated with different odds of transfer relative to admission within individual EDs after adjusting for the ED's proportion of patients with Medicaid (Medicaid OR: 1.0; 95{\%} CI: 0.8-1.1). CONCLUSIONS: Injured pediatric patients presenting to nondesignated trauma centers are slightly more likely to be transferred than admitted when the ED treats a higher proportion of Medicaid patients. In this study, ongoing concerns about inequities in the delivery of care among hospitals treating high proportions of children with Medicaid are reinforced.",
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N2 - OBJECTIVES: To determine if injured children presenting to nondesignated trauma centers are more or less likely to be transferred relative to being admitted based on insurance status. METHODS: We conducted a cross-sectional study by using the Healthcare Cost and Utilization Project Nationwide Emergency Department Sample. Pediatric trauma patients receiving care in emergency departments (EDs) at nontrauma centers who were either admitted locally or transferred to another hospital were included. We performed logistic regression analysis adjusting for injury severity and other confounders and incorporated nationally representative weights to determine the association between insurance and transfer or admission. RESULTS: Nine thousand four hundred and sixty-one ED pediatric trauma events at 386 nontrauma centers met inclusion criteria. EDs that treated a higher proportion of patients with Medicaid had higher odds of transfer relative to admission (odds ratio [OR]: 1.2 per 10% increase in Medicaid; 95% confidence interval [CI]: 1.1-1.4), resulting in overall higher odds of transfer among patients with Medicaid compared with patients with private insurance (OR: 1.3; 95% CI: 1.0-1.5). A patient's insurance status was not associated with different odds of transfer relative to admission within individual EDs after adjusting for the ED's proportion of patients with Medicaid (Medicaid OR: 1.0; 95% CI: 0.8-1.1). CONCLUSIONS: Injured pediatric patients presenting to nondesignated trauma centers are slightly more likely to be transferred than admitted when the ED treats a higher proportion of Medicaid patients. In this study, ongoing concerns about inequities in the delivery of care among hospitals treating high proportions of children with Medicaid are reinforced.

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