Insurance status and the transfer of hospitalized patients: an observational study.
Insurance status and the transfer of hospitalized patients: an observational study.
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DOI：
10.7326/m12-1977
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发表时间：
2014-01-21
影响因子：
39.2
通讯作者：
Cram P
中科院分区：
文献类型：
--
作者：
Hanmer J;Lu X;Rosenthal GE;Cram P
几乎没有客观证据支持人们的担忧，即患者根据保险状况在医院之间转移。探讨患者保险覆盖面与医院间转移的关系。我们分析了2010年全国住院患者样本的数据。所有年龄在18岁至之间的患者均已从美国急诊医院出院，且有五种常见诊断之一(胆道疾病、胸痛、肺炎、败血症、皮肤或皮下感染)。对于每个诊断，我们根据保险覆盖范围(私人、医疗保险、医疗补助和未投保)比较了住院患者被转移到另一家急性护理医院的比例。我们使用Logistic回归来估计未参保患者(参考类别-私人参保)的转院几率，同时调整患者和医院水平的因素。所有分析都纳入了抽样和分层后的权重。在我们确诊的1051家医院的315,748名出院患者中，转到其他急救医院的患者比例从1.3%(皮肤感染)到5.1%(败血症)不等。在未经调整的分析中，未参保的患者因三项诊断而转诊的可能性显着降低(p<；0.05)。在调整后的分析中，没有保险的患者在以下四种诊断中转移的可能性明显低于私人保险的患者：胆道疾病(OR)0.73(95%可信区间(CI)0.55-0.96)；胸痛(OR 0.63(CI 0.44-0.89))；败血症(OR 0.76(CI 0.64-0.91))；以及皮肤感染(OR 0.64(CI 0.46-0.89))。在所有诊断中，女性被转移的可能性明显低于男性。这一分析依赖于管理数据，缺乏临床细节。未参保的患者(和女性)进行医院间转院的可能性显著降低。转移率的差异可能会导致医疗保健方面的差异。
There is little objective evidence to support concerns that patients are transferred between hospitals based upon insurance status. To examine the relationship between patients’ insurance coverage and inter-hospital transfer. We analyzed data from the 2010 National Inpatient Sample. All patients aged 18-64 years discharged alive from U.S. acute care hospitals with one of five common diagnoses (biliary tract disease, chest pain, pneumonia, septicemia, skin or subcutaneous infection). For each diagnosis, we compared the proportion of hospitalized patients who were transferred to another acute-care hospital based upon insurance coverage (private, Medicare, Medicaid, and uninsured). We used logistic regression to estimate the odds of transfer for uninsured patients (reference category- privately insured) while adjusting for patient and hospital level factors. All analyses incorporated sampling and post-stratification weights. Among 315,748 patients discharged from 1051 hospitals with our five diagnoses, the percentage of patients transferred to another acute-care hospital varied from 1.3% (skin infection) to 5.1% (septicemia). In unadjusted analyses uninsured patients were significantly less likely to be transferred for three diagnoses (p<.05). In adjusted analyses, uninsured patients were significantly less likely to be transferred than privately insured patients for the four diagnoses: biliary tract disease (Odds Ratio (OR) 0.73 (95% Confidence interval (CI) 0.55-0.96)); chest pain (OR 0.63 (CI 0.44-0.89)); septicemia (OR 0.76 (CI 0.64-0.91)); and skin infections (OR 0.64 (CI 0.46-0.89)). Women were significantly less likely to be transferred than men for all diagnoses. This analysis relied on administrative data and lacked clinical detail. Uninsured patients (and women) were significantly less likely to undergo inter-hospital transfer. Differences in transfer rates may contribute to healthcare disparities.