Boston, Mass.; and Norfolk, Neb. From the Division of Plastic Surgery, Massachusetts General Hospital, Harvard Medical School; Faith Regional Health Services; and the Department of Orthopedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School.
Plast Reconstr Surg. 2013 Mar;131(3):593-600. doi: 10.1097/PRS.0b013e31827c6e82.
Academic institutions receive many patients transferred specifically for hand surgery evaluation. The purpose of this study was to evaluate the demographics and insurance status of patients transferred for this reason.
A retrospective review was performed of 155 transferred and 1017 nontransferred patients with a primary hand diagnosis during 3 summer months at two urban academic institutions. Patients were evaluated for insurance status/type, medical comorbidities, employment status, and reason for transfer. Insurance was defined as present/absent and favorable/unfavorable, with unfavorable defined as Medicaid or state-sponsored insurance. Reason for transfer or presenting diagnosis was separated by category.
The mean age was similar between groups, but a higher percentage of transfer patients were men (69.9 percent versus 59.7 percent; p < 0.05). The percentage of insured patients was similar (92.9 percent versus 93.2 percent), but the number with no insurance or undesirable insurance was greater for transferred patients (30.1 percent versus 22.9 percent; p < 0.05). Patients with poor or no insurance were twice as likely to be inappropriately transferred (OR, 2.17; p = 0.03). Transferred patients were less likely to be employed (55.1 percent versus 64.8 percent; p < 0.05); however, the percentages of workers' compensation (13.5 percent versus 14.6 percent) and diabetes (6.41 percent versus 6.10 percent) cases were similar. Common reasons for transfer were closed fractures/dislocations (21.9 percent), infection (17.4 percent), and amputation/devascularization (17.4 percent).
Patients transferred to tertiary care centers for emergency upper extremity evaluation have a higher rate of undesirable or no insurance and are more likely to be male or unemployed.
学术机构接收了许多专门因手部手术评估而转来的患者。本研究旨在评估因该原因转来的患者的人口统计学和保险状况。
对两家城市学术机构在 3 个夏季月期间的 155 例转院患者和 1017 例非转院患者的手部原发性诊断进行回顾性研究。评估患者的保险状况/类型、合并症、就业状况和转院原因。保险分为有/无和有利/不利，不利定义为医疗补助或州立保险。按类别将转院原因或现病史分开。
两组患者的平均年龄相似，但转院患者中男性比例较高（69.9%对 59.7%；p < 0.05）。参保患者的比例相似（92.9%对 93.2%），但转院患者无保险或保险不理想的比例更高（30.1%对 22.9%；p < 0.05）。保险状况差或无保险的患者更有可能被不当转院（OR，2.17；p = 0.03）。转院患者的就业率较低（55.1%对 64.8%；p < 0.05）；然而，工人赔偿（13.5%对 14.6%）和糖尿病（6.41%对 6.10%）的比例相似。转院的常见原因包括闭合性骨折/脱位（21.9%）、感染（17.4%）和截肢/血运重建（17.4%）。
因紧急上肢评估而转至三级护理中心的患者，保险状况不理想或无保险的比例较高，且更有可能为男性或失业。
