Jones Ruth Ellen, Gee Kristin M, Burkhalter Lorrie S, Beres Alana L
Division of Pediatric Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.
Children's Health, Dallas, Texas.
J Surg Res. 2018 Sep;229:216-222. doi: 10.1016/j.jss.2018.04.008. Epub 2018 May 1.
Tertiary referral centers provide specialty and critical care for patients presenting to hospitals that lack these resources. There is a notion among tertiary centers that outside hospitals are more likely to transfer uninsured or underinsured patients. We examined funding status of patients transferred to our tertiary pediatric hospital for surgical management of appendicitis, hypothesizing that transferred patients were more likely to have unfavorable coverage.
The electronic medical record was queried for all cases of laparoscopic appendectomy at our hospital between 2011 and 2015. Insurance was grouped into three categories: commercial, Medicaid/Children's Health Insurance Plan, or none. Transferred patients were compared to patients who presented directly.
A total of 5758 patients underwent laparoscopic appendectomy during the study period, of which 1683 (29.2%) were transfer patients. Transfer patients were more likely to be older, with a median age of 10.5 y versus 9.8 y in nontransferred patients (P ≤ 0.0001), and were more likely to be identified as non-Hispanic (50.0% versus 36.5%; P ≤ 0.0001). Insurance coverage was similar between groups. However, subgroup analysis of the hospitals that most frequently used our transfer services revealed a trend to transfer a higher proportion of Medicaid/Children's Health Insurance Plan patients.
Overall, pediatric patients transferred for laparoscopic appendectomy had similar insurance coverage to patients admitted directly, but subgroup analysis shows that not all centers follow this trend. Transfer patients were more frequently older and non-Hispanic. This builds upon the existing literature regarding the correlation of funding and transfer practices and highlights the need for additional research in this area.
三级转诊中心为那些就诊于缺乏相关资源医院的患者提供专科和重症护理。在三级中心存在一种观念，即外部医院更有可能转诊未参保或参保不足的患者。我们研究了转诊至我院接受阑尾炎手术治疗的患者的资金状况，推测转诊患者更有可能拥有不利的保险覆盖情况。
查询我院2011年至2015年间所有腹腔镜阑尾切除术病例的电子病历。保险分为三类：商业保险、医疗补助/儿童健康保险计划或无保险。将转诊患者与直接就诊的患者进行比较。
在研究期间，共有5758例患者接受了腹腔镜阑尾切除术，其中1683例（29.2%）为转诊患者。转诊患者年龄更大的可能性更高，中位年龄为10.5岁，而非转诊患者为9.8岁（P≤0.0001），且更有可能被认定为非西班牙裔（50.0%对36.5%；P≤0.0001）。两组之间的保险覆盖情况相似。然而，对最常使用我们转诊服务的医院进行的亚组分析显示，转诊医疗补助/儿童健康保险计划患者的比例有升高趋势。
总体而言，因腹腔镜阑尾切除术而转诊的儿科患者与直接入院的患者具有相似的保险覆盖情况，但亚组分析表明并非所有中心都遵循这一趋势。转诊患者年龄更大且更常为非西班牙裔。这以现有关于资金与转诊做法相关性的文献为基础，并突出了该领域进一步研究的必要性。
