Interhospital variability in time to discharge to rehabilitation among insured trauma patients

Abstract

Background: Hospital costs are partly a function of length of stay (LOS), which can be impacted by the local availability of post-acute care (PAC) resources (inpatient rehabilitation and skilled nursing facilities), particularly for injured patients. We hypothesized that LOS for trauma patients destined for PAC would be variable based on insurance type and hospitals from which they are discharged. Methods:We used the 2014-2015 National Inpatient Sample from the Healthcare Cost and Utilization Project (HCUP). We included all adult admissions with a primary diagnosis of trauma (ICD-9CM codes), who were insured and discharged to PAC. We then ranked hospitals based upon mean LOS and divided them into quartiles to determine differences. The primary outcome was inpatient LOS; secondary outcome was cost.Results: 958,005 trauma patients met inclusion criteria. Mean LOS varied based upon insurance type (Medicaid vs. Private vs. Medicare: 12.7 days vs. 8.8 and 5.7: p<0.001). Shortest LOS hospitals had a marginal variation in LOS (Medicaid vs. Private vs. Medicare: 5.5 days vs. 4.8 vs. 4.2, p<0.001). Longest LOS hospitals had mean LOS that varied substantially (16.4 vs. 11.0 vs. 6.7 days, p<0.001). Multivariate regression controlling for patient and hospital characteristics revealed that Medicaid patients spent Medicaid patients spent an additional 0.4 days in shortest LOS hospitals and an additional 2.6 days in longest LOS hospitals (p<0.001). The average daily

Association of the Affordable Care Act Medicaid Expansion with Trauma Outcomes and Access to Rehabilitation among Young Adults: Findings Overall, by Race and Ethnicity, and Community Income Level

“… 8 , 25 , 59 , 60 The paucity of post-discharge care facilities in some regions can create a bottleneck for patients awaiting discharge to these specialized services and, when combined with variation across states and hospitals over time in decision making about admitting vs observing nonseverely injured patients, contributes to variability in LOS among admitted trauma patients. 61 In contrast, the difference in reported access to home healthcare is likely a result of study cohort selection. Home healthcare is typically reserved for patients in need of assistance with wound care or activities of daily living.…”

“…An emphasis on decreasing regional variability in access to quality post-discharge services could improve healthcare outcomes and decrease the cost of care by minimizing inefficiencies in the current system. 61 …”

Emergency Medicaid programs may be an effective means of providing sustained insurance among trauma patients: A statewide longitudinal analysis

“…5 Lack of insurance among trauma patients has also been shown to limit access to rehabilitation and follow-up care and increase the financial burden of trauma. [17][18][19] Despite a nearly 18 million person reduction in uninsured persons since the implementation of the Affordable Care Act in 2014, coverage gains now appear to be stalling across many states and individuals commonly cite challenges accessing health care because of prohibitive costs. 20 Medicaid programs are the nation's largest public health insurance program, providing coverage to nearly one in five Americans younger than 65 years, including low-income individuals.…”

“…Trauma patients are repeatedly and disproportionately impacted by insurance-related outcomes disparities, including delays in care and even failure to access necessary services, higher mortality and worse long-term prognosis, independent of sociodemographic factors and injury severity 5 . Lack of insurance among trauma patients has also been shown to limit access to rehabilitation and follow-up care and increase the financial burden of trauma 17–19 . Despite a nearly 18 million person reduction in uninsured persons since the implementation of the Affordable Care Act in 2014, coverage gains now appear to be stalling across many states and individuals commonly cite challenges accessing health care because of prohibitive costs 20 .…”

Quality care is equitable care: a call to action to link quality to achieving health equity within acute care surgery

“…This includes patient relationships with healthcare providers, hospital systems, the legal system, and societal beliefs to understand modifiable factors that contribute to differences in clinical outcomes. Surgical disparities have been described among acute care surgery patients based on race, socioeconomic status, sexual orientation, disability and insurance status 2–4. Furthermore, geographical differences influence access to healthcare, particularly trauma, which can vary greatly between urban and rural markets.…”