Rees Chris A, Pryor Stephanie, Choi Ben, Senthil Mamata V, Tsarouhas Nicholas, Myers Sage R, Monuteaux Michael C, Bachur Richard G, Li Joyce
Division of Emergency Medicine, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, BCH 3066, Boston, MA 02115, USA.
Department of Pediatrics, Seattle Children's Hospital, University of Washington School of Medicine, 4800 Sand Point Way NE, Seattle, WA 98105, USA.
Am J Emerg Med. 2017 Dec;35(12):1907-1909. doi: 10.1016/j.ajem.2017.07.048. Epub 2017 Jul 19.
Disparities exist in the care children receive in the emergency department (ED) based on their insurance type. It is unknown if these differences exist among children transferred from outside EDs to pediatric tertiary care EDs.
To compare reasons for transfer and services received at pediatric tertiary care EDs between children with private and public insurance.
We performed a secondary analysis of a multicenter survey of ED providers transferring patients to pediatric tertiary care EDs in three major U.S. cities. Risk differences (RD) and 95% confidence intervals (CI) were calculated to compare reasons for transfer and care received at pediatric tertiary care EDs based on insurance type.
There were 561 surveys completed by transferring providers describing reasons for transfer to pediatric tertiary care EDs with 52.2% of patients with private insurance and 47.8% with public insurance. We found no significant differences between privately and publicly insured children in reason for transfer for subspecialty consultation or need for admission. We found no significant differences in frequency of admission, radiologic studies, or ED procedures at the receiving facilities. However, a greater proportion of privately insured children had a subspecialty consultation at receiving facilities compared to publicly insured children (RD 9.7, 95% CI 2.0 to 17.4).
Transferred pediatric patients with private insurance were more likely to have subspecialty consultations than children with public insurance. Further studies are needed to better characterize the interplay between patients' insurance type and both the request for, and the provision of, ED subspecialty consultations.
儿童在急诊科接受的护理因保险类型而异。目前尚不清楚这些差异是否存在于从外部急诊科转至儿科三级护理急诊科的儿童中。
比较私立保险和公立保险儿童转至儿科三级护理急诊科的转诊原因及接受的服务。
我们对一项多中心调查进行了二次分析，该调查涉及美国三个主要城市将患者转至儿科三级护理急诊科的急诊科提供者。计算风险差异（RD）和95%置信区间（CI），以比较基于保险类型的转至儿科三级护理急诊科的转诊原因及接受的护理。
转诊提供者完成了561份调查问卷，描述了转至儿科三级护理急诊科的原因，其中52.2%的患者有私立保险，47.8%的患者有公立保险。我们发现，在因专科会诊转诊或需要住院方面，有私立保险和公立保险的儿童之间没有显著差异。我们发现，接收机构在住院频率、放射学检查或急诊程序方面没有显著差异。然而，与有公立保险的儿童相比，有私立保险的儿童在接收机构接受专科会诊的比例更高（RD 9.7，95%CI 2.0至17.4）。
与有公立保险的儿童相比，有私立保险的转诊儿科患者更有可能接受专科会诊。需要进一步研究，以更好地描述患者保险类型与急诊专科会诊的请求和提供之间的相互作用。
