Association of Emergency Department Evaluation With Public Insurance Use and Treatment Delays for ACL Injury.
Association of Emergency Department Evaluation With Public Insurance Use and Treatment Delays for ACL Injury.
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DOI：
10.1177/23259671231212241
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发表时间：
2023-11
影响因子：
2.6
通讯作者：
Owens, Brett D.
中科院分区：
文献类型：
--
作者：
Zhu, Angela S.;Morrissey, Patrick;Byrne, Rory A.;Albright, J. Alex;Lemme, Nicholas J.;Cruz, Aristides I.;Owens, Brett D.
前交叉韧带（ACL）损伤的急诊（艾德）就诊费用高且诊断不可靠。最初在艾德接受ACL损伤评估的患者更有可能来自低收入四分位数，使用公共保险，并且治疗延迟。队列研究;证据等级，3。使用当前手术术语（CPT）代码29888识别罗得岛所有付款人索赔数据库中在2012年至2021年期间接受ACL重建（ACLR）的患者。根据艾德CPT代码或ACLR 1年内的门诊服务，将患者分层为2个队列。卡方分析用于检验队列之间患者和手术特征的差异。多变量线性和逻辑回归用于确定艾德评估如何影响时间和结果变量。在调整患者和手术特征后，艾德队列中的患者更有可能获得医疗补助（29%对12.5%; P <0.001），并且处于最低收入四分位数（44.6%对32.1%; P <0.001）。艾德就诊和医疗补助状况与到（1）诊断性磁共振成像的时间增加相关，平均增加7.97天（95% CI，4.14-11.79天; P < .001）和8.40天（95% CI，3.44-13.37天; P = .001）;（2）手术，增加20.30天（95% CI，14.10-26.49天; P <0.001）和12.88天（95% CI，5.15-20.60天; P = 0.001）。在艾德接受评估的年龄>40岁的患者需要后续ACLR的可能性是其他患者的2.5倍（比值比，2.50 [95% CI，1.01-6.21]; P = 0.049）。在这项研究中，在40-49岁年龄组中，在ACLR前1年内就诊于艾德的患者更有可能收入较低，公共保险，诊断成像时间增加，手术时间增加，术后物理治疗使用减少，随后的ACLR率增加。
Utilization of an emergency department (ED) visit for anterior cruciate ligament (ACL) injury is associated with high cost and diagnostic unreliability. Patients initially evaluated at an ED for an ACL injury would be more likely to be from a lower income quartile, use public insurance, and experience a delay in treatment. Cohort study; Level of evidence, 3. Patients in the Rhode Island All Payers Claims Database who underwent ACL reconstruction (ACLR) between 2012 and 2021 were identified using the Current Procedure Terminology (CPT) code 29888. Patients were stratified into 2 cohorts based on CPT codes for ED or in-office services within 1 year of ACLR. A chi-square analysis was used to test for differences between cohorts in patient and surgical characteristics. Multivariable linear and logistic regression were used to determine how ED evaluation affected timing and outcome variables. While adjusting for patient and operative characteristics, patients in the ED cohort were more likely to have Medicaid (29% vs 12.5%; P < .001) and be in the lowest income quartile (44.6% vs 32.1%; P < .001). ED visit and Medicaid status were associated with increased time to (1) diagnostic magnetic resonance imaging, adding 7.97 days on average (95% CI, 4.14-11.79 days; P < .001) and 8.40 days (95% CI, 3.44-13.37 days; P = .001), respectively; and (2) surgery, adding 20.30 days (95% CI, 14.10-26.49 days; P < .001) and 12.88 days (95% CI, 5.15-20.60 days; P = .001), respectively. Patients >40 years who were evaluated in the ED were 2.5 times more likely to require subsequent ACLR (odds ratio, 2.50 [95% CI, 1.01-6.21]; P = .049). In this study, patients who visited the ED within 1 year before ACLR were more likely to have a lower income, public insurance, increased time to diagnostic imaging, and increased time to surgery, as well as decreased postoperative physical therapy use and increased subsequent ACLR rates in the 40-49 years age-group.
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