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上肢创伤患者的护理转移:健康保险类型的影响

Care Transfers for Patients With Upper Extremity Trauma: Influence of Health Insurance Type.

作者信息

Mahmoudi Elham, Squitieri Lee, Maroukis Brianna L, Chung Kevin C, Waljee Jennifer F

机构信息

Department of Surgery, Section of Plastic Surgery, University of Michigan Medical School, Ann Arbor, MI.

Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Southern California, Los Angeles, CA; Robert Wood Johnson Clinical Scholars Program, University of California, Los Angeles, CA.

出版信息

J Hand Surg Am. 2016 Apr;41(4):516-525.e3. doi: 10.1016/j.jhsa.2016.01.010. Epub 2016 Feb 12.

Abstract

PURPOSE

To understand the differences in transfer incidence for patients with upper extremity trauma by hospital trauma center designation. We hypothesized that patients with public or no insurance were more likely to be transferred to another facility compared with privately insured patients.

METHODS

Trauma centers are designated by local authorities and verified by the American College of Surgeons. Using the 2012 National Trauma Data Bank, we examined the probability of being transferred from one center to another for patients who sustained isolated upper extremity trauma. We used multivariable logistic regression with a clustered variance method to adjust for intrahospital correlation to compare risk-adjusted transfer incidence for patients with upper extremity injuries by trauma center designation.

RESULTS

In 2012, 6,214 patients ages 18-64 with isolated upper extremity trauma presented to 477 hospitals. Overall, transfer incidence was significantly higher among level III trauma centers (26%) compared with level II (11%) or level I (2%) trauma centers. Adjusting for patient and hospital characteristics patients with Medicaid were more likely to be transferred from level III trauma centers to another center compared with privately insured patients.

CONCLUSIONS

Current regulations may not prevent unnecessary patient transfers based on insurance status among level III trauma centers. Policy makers should compensate or provide incentives to hospitals that take care of poorly insured patients.

TYPE OF STUDY/LEVEL OF EVIDENCE: Economic/decision III.

摘要

目的

通过医院创伤中心的指定来了解上肢创伤患者的转院发生率差异。我们假设,与有私人保险的患者相比,有公共保险或无保险的患者更有可能被转至其他机构。

方法

创伤中心由地方当局指定并经美国外科医师学会核实。利用2012年国家创伤数据库,我们研究了单纯上肢创伤患者从一个中心转至另一个中心的可能性。我们使用多变量逻辑回归和聚类方差方法来调整院内相关性,以比较按创伤中心指定划分的上肢损伤患者的风险调整转院发生率。

结果

2012年,477家医院收治了6214例年龄在18至64岁之间的单纯上肢创伤患者。总体而言,III级创伤中心的转院发生率(26%)显著高于II级(11%)或I级(2%)创伤中心。在对患者和医院特征进行调整后,与有私人保险的患者相比,医疗补助患者更有可能从III级创伤中心转至另一个中心。

结论

现行规定可能无法防止III级创伤中心基于保险状况进行不必要的患者转院。政策制定者应补偿或激励照顾保险不足患者的医院。

研究类型/证据水平:经济/决策III级。

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