Insurance status influences emergent designation in surgical transfers

The Journal of Surgical Research
Kristy Kummerow BromanBenjamin K Poulose

Abstract

There is a perception among surgeons that hospitals disproportionately transfer unfavorably insured patients for emergency surgical care. Emergency medical condition (EMC) designation mandates referral center acceptance of patients for whom transfer is requested. We sought to understand whether unfavorably insured patients are more likely to be designated as EMCs. A retrospective cohort study was performed on patient transfers from a large network of acute care facilities to emergency surgery services at a tertiary referral center from 2009-2013. Insurance was categorized as favorable (commercial or Medicare) or unfavorable (Medicaid or uninsured). The primary outcome, transfer designation as EMC or non-EMC, was evaluated using multivariable logistic regression. A secondary analysis evaluated uninsured patients only. There were 1295 patient transfers in the study period. Twenty percent had unfavorable insurance. Favorably insured patients were older with fewer nonwhite, more comorbidities, greater illness severity, and more likely transferred for care continuity. More unfavorably insured patients were designated as EMCs (90% versus 84%, P < 0.01). In adjusted models, there was no association between unfavorable insurance and EM...Continue Reading

References

May 24, 2001·The Journal of Trauma·A B NathensG J Jurkovich
Jul 27, 2005·Academic Medicine : Journal of the Association of American Medical Colleges·Adrienne GreenLee Goldman
May 12, 2009·American Journal of Surgery·Jennifer ParksShahid Shafi
Jul 16, 2009·Hand : Official Journal of the American Association for Hand Surgery·Edward T MelkunJames Chang
Nov 26, 2009·Emergency Medicine Clinics of North America·Paul A Testa, Maureen Gang
Jul 20, 2012·Critical Care Medicine·Theodore J Iwashyna
Jul 28, 2012·The Journal of Trauma and Acute Care Surgery·Nickolas J NahmHeather A Vallier
Dec 21, 2012·The New England Journal of Medicine·John A Graves
Mar 1, 2013·Plastic and Reconstructive Surgery·Kyle R EberlinCharles Day
Sep 17, 2013·Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine·Jacob NachtAdit A Ginde
Dec 18, 2013·Annals of Emergency Medicine·Dana R KindermannJesse M Pines
Apr 29, 2014·Journal of Vascular Surgery·Matthew W MellTina Hernandez-Boussard

❮ Previous
Next ❯

Citations

Nov 30, 2016·Applied Health Economics and Health Policy·Kathleen A FairmanDavid A Sclar

❮ 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.