Insurance-Based Disparities in Stroke Center Access in California: A Network Science Approach.
Insurance-Based Disparities in Stroke Center Access in California: A Network Science Approach.
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加州中风中心访问中基于保险的差异：网络科学方法。
DOI：
10.1161/circoutcomes.122.009868
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发表时间：
2023
期刊：
影响因子：
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通讯作者：
Onnela,Jukka-Pekka
中科院分区：
文献类型：
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作者：
Zachrison,KoriS;Hsia,ReneeY;Schwamm,LeeH;Yan,Zhiyu;Samuels-Kalow,MargaretE;Reeves,MathewJ;CamargoJr,CarlosA;Onnela,Jukka-Pekka
我们的目标是确定缺血性卒中患者保险和转移的可能性之间是否存在关联，以及是否有医院集群修改了保险和卒中中心transfer. METHODS之间的关联，这一回顾性网络分析加州数据包括2010年至2017年的每一个非联邦医院缺血性卒中入院。根据患者是否从卒中中心（主要或综合）出院，对从急诊科转移到另一家医院进行分类。我们使用逻辑回归模型来检查保险（私人，医疗保险，医疗补助，未投保）和（1）最初到非卒中中心医院急诊科的患者中的任何转移和（2）转移到卒中中心的患者之间的关系。我们使用网络聚类方法来识别通过转移紧密连接的医院集群。在每个聚类中，我们量化了从卒中中心出院的转移比例最高和最低的保险组之间的差异。在332 995例缺血性卒中病例中，51%为女性，70% ≥65岁，3.5%从最初的急诊科转移。 在非卒中中心就诊的52316例患者中，3466例（7.1%）被转移。相对于私人保险的患者，所有组中转移和转移到卒中中心的几率较低（医疗保险比值比，0.24 [95%CI，0.22-0.26]和0.59 [95%CI，0.50-0.71]，医疗补助比值比，0.26 [95%CI，0.23-0.29]和比值比，0.49 [95%CI，0.38-0.62]，未投保的比值比分别为0.75 [95%CI，0.63-0.89]和0.72 [95%CI，0.6-0.8]）。在14个确定的医院集群，保险为基础的差异转移变化和最低性能的集群（也是最大的; n=2364转让）充分解释了保险为基础的差异中风中心transfer.CONCLUSIONSUninsured患者的几率中风中心通过转移比有保险的患者。这种差异在很大程度上是由一个特定医院联网的模式解释的。
BACKGROUNDOur objectives were to determine whether there is an association between ischemic stroke patient insurance and likelihood of transfer overall and to a stroke center and whether hospital cluster modified the association between insurance and likelihood of stroke center transfer.METHODSThis retrospective network analysis of California data included every nonfederal hospital ischemic stroke admission from 2010 to 2017. Transfers from an emergency department to another hospital were categorized based on whether the patient was discharged from a stroke center (primary or comprehensive). We used logistic regression models to examine the relationship between insurance (private, Medicare, Medicaid, uninsured) and odds of (1) any transfer among patients initially presenting to nonstroke center hospital emergency departments and (2) transfer to a stroke center among transferred patients. We used a network clustering method to identify clusters of hospitals closely connected through transfers. Within each cluster, we quantified the difference between insurance groups with the highest and lowest proportion of transfers discharged from a stroke center.RESULTSOf 332 995 total ischemic stroke encounters, 51% were female, 70% were ≥65 years, and 3.5% were transferred from the initial emergency department. Of 52 316 presenting to a nonstroke center, 3466 (7.1%) were transferred. Relative to privately insured patients, there were lower odds of transfer and of transfer to a stroke center among all groups (Medicare odds ratio, 0.24 [95% CI, 0.22–0.26] and 0.59 [95% CI, 0.50–0.71], Medicaid odds ratio, 0.26 [95% CI, 0.23–0.29] and odds ratio, 0.49 [95% CI, 0.38–0.62], uninsured odds ratio, 0.75 [95% CI, 0.63–0.89], and 0.72 [95% CI, 0.6–0.8], respectively). Among the 14 identified hospital clusters, insurance-based disparities in transfer varied and the lowest performing cluster (also the largest; n=2364 transfers) fully explained the insurance-based disparity in odds of stroke center transfer.CONCLUSIONSUninsured patients had less stroke center access through transfer than patients with insurance. This difference was largely explained by patterns in 1 particular hospital cluster.