Impact of insurance status on ability to return for outpatient management of pediatric supracondylar humerus fractures

Fletcher, Nicholas D.; Sirmon, Bryan J.; Mansour, Ashton S.; Carpenter, William E.; Ward, Laura

doi:10.1007/s11832-016-0769-x

Cited by 20 publications

(22 citation statements)

References 38 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This study established that Health Insurance was a determinant of orthopaedic services utilisation, similar to studies on Household Health expenditure Surveys noted in the literature review section, and assertions by Fletcher, (2016). Clients without health insurance were 83 percent less likely to use orthopaedic services compared to those with Insurance and this difference was statistically different at p = 0.003.…”

Section: Client Demographic and Social Characteristics Have A Bearingsupporting

confidence: 80%

Determinants of Orthopaedic Service Utilisation among Young People Aged 5-24 Years Old in Zambia

Seketi¹,

Simuyemba²,

Likwa³

2020

Preprint

View full text Add to dashboard Cite

Background Musculoskeletal conditions and/or disorders (MSDs), which affect muscles, tendons and ligaments, are the main causes of disability in many patients even though such disorders can be addressed through orthopaedic care. Little was known on the determinants of Orthopaedic services utilisation among young people between the ages of 5-24 in Zambia.Methods An embedded mixed methods design was used to conduct a hospital based cross sectional study that focused on high and low level of orthopaedic services utilisation. Stratified random sampling was used to draw a sample of 162 children and young people (5-24) from the hospital registers. Purposive sampling was used for eight service providers and convenient sampling for 10 parents and six young people. A data extraction checklist and self-administered questionnaires were for service providers. In-depth interviews with parents and a focus group discussion with six clients aged 15 to 24. Quantitative data was analysed using STATA version 14. Statistical tests included chi square, univariate and investigator led stepwise multiple logistic regression. Content and thematic analysis were done for qualitative data.Results 41 percent of clients had high level of service utilisation. Physiotherapy clients were 84 percent significantly less likely to use services compared to clients from prosthetic and orthotics workshops [AOR 0.16; 95% CI 0.05, 0.59; P=0.01]. Clients living in low density residential areas were 86 percent times less likely to use Orthopaedic services compared to those in high density residential areas [AOR 0.14; 95% CI 0.05, 0.43; P<0.0001]. Participants without Insurance were 83 percent less likely to use Orthopaedic services compared to those with Insurance [AOR 0.17; 95% CI 0.05, 0.55; P=0.003]. At service level, barriers were inadequate financial and human resources. For care givers,key barriers included inadequate information about practices and other essential health actions to manage MSDs at home; costs of transport and fear of marital discord to discuss matters at length.Conclusion The type of service used, area of residence and Health Insurance are significant determinants of Orthopaedic services utilisation. It is highly recommended that such services be decentralised to address key family barriers. Inadequate resources for orthopaedic service provision also need to be adequately addressed.

show abstract

Section: Client Demographic and Social Characteristics Have A Bearingsupporting

confidence: 80%

Determinants of Orthopaedic Service Utilisation among Young People Aged 5-24 Years Old in Zambia

Seketi¹,

Simuyemba²,

Likwa³

2020

Preprint

View full text Add to dashboard Cite

show abstract

“…This finding is similar to a previous analysis that identified an association between surgery for upper extremity fracture and private insurance [ 29 ]. Additionally, previous analysis of supracondylar humerus fractures treated as outpatients in the pediatric population found that privately insured patients were nearly two and a half times as likely to return for surgical intervention than those with public or no insurance [ 30 ]. This independent association between lower surgical intervention rates and non-private insurance may be a barrier to care that pushes the treating surgeon to admit these patients rather than discharge for outpatient follow-up.…”

Section: Discussionmentioning

confidence: 99%

Humeral shaft fractures: national trends in management

et al. 2017

View full text Add to dashboard Cite

BackgroundThe incidence of humeral shaft fractures has been increasing over time. This represents a growing public health concern in a climate of cost containment. The purpose of this study is to analyze national trends in surgical management of humeral shaft fractures and determine factors predictive of surgical intervention.Materials and methodsHumeral shaft fractures were identified by the International Classification of Diseases, Ninth Revision, Clinical Modification codes 812.21 and 812.31 in the United States Nationwide Inpatient Sample from 2002 to 2011. Open reduction and internal fixation (ORIF) was identified by code 79.31 (ORIF, humerus). Other case codes analyzed were 79.01 (closed reduction without internal fixation), 79.11 (closed reduction with internal fixation), and 79.21 (open reduction without internal fixation). Multivariate regression analysis was utilized to determine predictive factors for utilization of ORIF.Results27,908 humeral shaft fractures were identified. Utilization of ORIF increased from 47.2% of humeral shaft fractures in 2002 to 60.3% in 2011. Demographically, patients who underwent ORIF were younger (51.5 versus 59.7 years, p < 0.001; odds ratio 0.87 per decade of age). There were modest increases in ORIF usage with private insurance, open fracture, and hospital size, which persisted with multivariate regression analysis. Surprisingly, there was a tendency to shift from a slight increase in ORIF for males with the bivariate case to a slight preference for females in the multivariate case.ConclusionUtilization of ORIF for humeral shaft fractures has been steadily increasing with time. Surgical intervention was more common with younger patients, female gender, private insurance, and larger hospital size. The increasing incidence of surgical management for humeral shaft fractures may represent a public health burden given the historical success of non-operative management.Level of evidenceIV.

show abstract

“…This risk has been borne out in previous literature; however, this study further characterized this risk based on timeline. 1 2 3 4 5 6 , 12 , 19 - 21 , 26 , 27 The delay between injury and referral for patients with government-funded insurance was 2.8 times higher than patients with commercial insurance. This delay directly affects the time to orthopaedic evaluation, where the average wait time, for these patients, is almost twice as long at 9.2 days over commercial insurance patients.…”

Section: Discussionmentioning

confidence: 98%

“…Pediatric orthopaedic patients with government-funded health insurance experience longer periods of time before receiving definitive treatment compared with commercially-insured patients at a national level. 1 2 3 4 5 6 , 9 , 19 20 21 22 23 24 The current literature successfully identifies these issuess but has been unable to determine why the issue exists or provide solutions that generate meaningful change. Our study attempts to localize this issue based on the timeline of care.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Inequalities in Pediatric Fracture Care Timeline Based on Insurance Type

et al. 2020

View full text Add to dashboard Cite

Introduction: Socioeconomic and insurance status are often linked with limited access to health care. Despite several government-funded projects aimed at curtailing these barriers, pediatric orthopaedic patients continue to experience delays in receiving timely care for fracture treatments. This delay has been well-identified within the orthopaedic literature but, to our knowledge, has never been characterized based on timeline. Thus, the goal of this study is to evaluate the role of ethnicity, socioeconomic status, and insurance type on the timeline of pediatric patients to obtain orthopaedic care within our community. Methods: Pediatric patients presenting to our clinic for the treatment of one of 21 most common fractures were included. Patient demographics and the timeline of patient care were collected by retrospective chart review. Results: Government-funded insurance accounted for 60.6% of the 413 patients. These patients experienced significant ( P < 0.001) delays in access to care when compared with commercial insurance patients; the time between injury and referral as well as the overall time from injury to orthopaedic evaluation was 2.8 and twofold greater at 4.4 days and 9.2 days, respectively. A strong correlation was established between income levels and insurance type. Discussion: Pediatric patients with a lower socioeconomic status are more likely to rely on government-funded insurance and experience delays in fracture evaluation.

show abstract

Impact of insurance status on ability to return for outpatient management of pediatric supracondylar humerus fractures

Cited by 20 publications

References 38 publications

Determinants of Orthopaedic Service Utilisation among Young People Aged 5-24 Years Old in Zambia

Determinants of Orthopaedic Service Utilisation among Young People Aged 5-24 Years Old in Zambia

Humeral shaft fractures: national trends in management

Inequalities in Pediatric Fracture Care Timeline Based on Insurance Type

Contact Info

Product

Resources

About