Admit or transfer? The role of insurance in high-transfer-rate medical conditions in the emergency department

Annals of Emergency Medicine
Dana R KindermannJesse M Pines

Abstract

We study the association of payer status with odds of transfer compared with admission from the emergency department (ED) for multiple diagnoses with a high percentage of transfers. This was a retrospective study of adult ED encounters using the Healthcare Cost and Utilization Project 2010 Nationwide Emergency Department Sample. We used the Clinical Classification Software to identify disease categories with 5% or more encounters resulting in transfer (27 categories; 3.7 million encounters based on survey weights). We sorted encounters by condition into 12 groups according to expected medical or surgical specialist needs. We used logistic regression to assess the role of payer status on odds of transfer compared with admission and report adjusted odds ratios (ORs). Among high-transfer conditions in 2010, uninsured patients had double the odds of transfer compared with privately insured patients (OR 2.12; 95% confidence interval [CI] 1.72 to 2.62). Medicaid patients were also more likely to be transferred (OR 1.2; 95% CI 1.04 to 1.38). Uninsured patients had higher odds of transfer in all specialist categories (significant in 9 of 12). The categories with the highest odds of transfer for the uninsured included nephrology (OR 2.4...Continue Reading

References

Feb 7, 1998·Medical Care·A ElixhauserR M Coffey
Apr 27, 1999·The Journal of Trauma·J S SampalisD Mulder
May 24, 2001·The Journal of Trauma·A B NathensG J Jurkovich
May 17, 2002·The American Journal of Medicine·Jerry H GurwitzJoel M Gore
May 16, 2003·Emergency Medicine Journal : EMJ·A GrayR Williams
Sep 23, 2003·The Journal of Trauma·Avery B NathensDavid C Grossman
Oct 1, 2003·Health Affairs·Paul S Appelbaum
Nov 27, 2004·Journal of Emergency Nursing : JEN : Official Publication of the Emergency Department Nurses Association·Patricia Southard
Oct 4, 2006·The Journal of Bone and Joint Surgery. American Volume·Kenneth J KovalKevin F Spratt
Dec 13, 2006·The Journal of Trauma·Thomas J EspositoFred A Luchette
Apr 12, 2007·The Journal of Trauma·Stephen M CohnBasil A Pruitt
Nov 6, 2007·JAMA : the Journal of the American Medical Association·James G JollisUNKNOWN Reperfusion of Acute Myocardial Infarction in North Carolina Emergency Departments (RACE) Investigators
Dec 7, 2007·The Journal of Bone and Joint Surgery. American Volume·Michael T ArchdeaconJohn D Wyrick
Jul 16, 2009·Hand : Official Journal of the American Association for Hand Surgery·Edward T MelkunJames Chang
Jan 16, 2010·Annals of Emergency Medicine·Pamela L OwensRyan L Mutter
May 27, 2010·Journal of Orthopaedic Trauma·Nikhil A ThakurMichael G Ehrlich
Oct 13, 2010·Archives of Neurology·Karen C AlbrightBrendan G Carr
Dec 24, 2010·Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine·Tabitha GarwePatrice Greenawalt
Sep 10, 2011·Journal of Orthopaedic Trauma·Robert Victor CantuDavid M Pober
Dec 21, 2011·The Journal of Trauma·Andrea D HillAvery B Nathens

❮ Previous
Next ❯

Citations

Sep 9, 2015·The Journal of Surgical Research·Kristy Kummerow BromanBenjamin K Poulose
Feb 3, 2015·Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine·Dana R KindermannJesse M Pines
Feb 3, 2015·Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine·Dana R KindermannJesse M Pines
Feb 12, 2015·Annals of Emergency Medicine·Ryan Mutter, Carol Stocks
Apr 14, 2015·The American Journal of Emergency Medicine·William D SpectorPamela Owens
Dec 4, 2014·The American Journal of Emergency Medicine·Mariano E Menendez, David Ring
Jun 11, 2016·The American Journal of Cardiology·Michael J WardWesley H Self
May 7, 2016·Hospital Pediatrics·Jennifer L RosenthalMegumi J Okumura
Aug 25, 2016·Annals of Emergency Medicine·Yunru HuangJames P Marcin
Jan 10, 2017·Annals of Emergency Medicine·Laura Medford-DavisEmily Carrier
Jan 31, 2018·Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine·Jesse M PinesBernard S Black
Aug 29, 2017·Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine·Laura N Medford-DavisKarin V Rhodes
Apr 18, 2018·The Journal of Trauma and Acute Care Surgery·Michael P DeWaneRobert D Becher
Apr 2, 2019·JAMA Internal Medicine·Arjun K VenkateshKumar Dharmarajan
Jun 28, 2019·Trauma Surgery & Acute Care Open·Heena SantryMarie Crandall
Oct 3, 2018·Journal of General Internal Medicine·Michael G UsherDana Herrigel
May 8, 2018·Journal of Healthcare Management / American College of Healthcare Executives·Kathryn R FingarCarol Stocks
May 28, 2019·BMC Health Services Research·Linxin LiuMin Yang
Nov 19, 2019·The Western Journal of Emergency Medicine·Juan Carlos C MontoyChristopher R Peabody
Oct 2, 2020·Journal of the American College of Emergency Physicians Open·Jay M BrennerDaniel R Martin
Dec 29, 2020·The American Journal of Emergency Medicine·Sara Fernandes-TaylorAngela Ingraham
Jan 2, 2018·Joint Commission Journal on Quality and Patient Safety·Kristy Kummerow BromanMargaret L Schwarze
Nov 27, 2019·The Journal of Surgical Research·Manuel Castillo-AngelesJoaquim M Havens
Jul 6, 2019·Pediatric Emergency Care·Jamie L KisseeJames P Marcin

❮ Previous
Next ❯

Related Concepts

Trending Feeds

COVID-19

Coronaviruses encompass a large family of viruses that cause the common cold as well as more serious diseases, such as the ongoing outbreak of coronavirus disease 2019 (COVID-19; formally known as 2019-nCoV). Coronaviruses can spread from animals to humans; symptoms include fever, cough, shortness of breath, and breathing difficulties; in more severe cases, infection can lead to death. This feed covers recent research on COVID-19.

Blastomycosis

Blastomycosis fungal infections spread through inhaling Blastomyces dermatitidis spores. Discover the latest research on blastomycosis fungal infections here.

Nuclear Pore Complex in ALS/FTD

Alterations in nucleocytoplasmic transport, controlled by the nuclear pore complex, may be involved in the pathomechanism underlying multiple neurodegenerative diseases including Amyotrophic Lateral Sclerosis and Frontotemporal Dementia. Here is the latest research on the nuclear pore complex in ALS and FTD.

Applications of Molecular Barcoding

The concept of molecular barcoding is that each original DNA or RNA molecule is attached to a unique sequence barcode. Sequence reads having different barcodes represent different original molecules, while sequence reads having the same barcode are results of PCR duplication from one original molecule. Discover the latest research on molecular barcoding here.

Chronic Fatigue Syndrome

Chronic fatigue syndrome is a disease characterized by unexplained disabling fatigue; the pathology of which is incompletely understood. Discover the latest research on chronic fatigue syndrome here.

Evolution of Pluripotency

Pluripotency refers to the ability of a cell to develop into three primary germ cell layers of the embryo. This feed focuses on the mechanisms that underlie the evolution of pluripotency. Here is the latest research.

Position Effect Variegation

Position Effect Variagation occurs when a gene is inactivated due to its positioning near heterochromatic regions within a chromosome. Discover the latest research on Position Effect Variagation here.

STING Receptor Agonists

Stimulator of IFN genes (STING) are a group of transmembrane proteins that are involved in the induction of type I interferon that is important in the innate immune response. The stimulation of STING has been an active area of research in the treatment of cancer and infectious diseases. Here is the latest research on STING receptor agonists.

Microbicide

Microbicides are products that can be applied to vaginal or rectal mucosal surfaces with the goal of preventing, or at least significantly reducing, the transmission of sexually transmitted infections. Here is the latest research on microbicides.