Department of Neurosurgery, West Virginia University, Morgantown, West Virginia, USA.
Department of Surgery, West Virginia University, Morgantown, West Virginia, USA.
J Spinal Cord Med. 2020 Jan;43(1):106-110. doi: 10.1080/10790268.2018.1544878. Epub 2018 Dec 3.
Medicaid has been linked to worse outcomes in a variety of diagnoses such as lung cancer, uterine cancer, and cardiac valve procedures. It has furthermore been linked to the reduced health-related quality of life outcomes after traumatic injuries when compared to other insurance groups. In spinal cord injury (SCI), the care provided in the subacute setting may vary based upon payor status, which may have implications on outcomes and cost of care. A retrospective review utilizing the institutional trauma databank was performed for all adult patients with spinal cord injury since 2009. Pediatric patients were excluded. Insurance type, race, length of stay, discharge status (alive/dead), discharge disposition, injury severity score (ISS), and hospital charges billed were recorded. Two hundred patients were identified. Overall 27.5% of patients with SCI during the period of our review were Medicaid beneficiaries. ISS was similar between Medicaid and non-Medicaid patients, but the Medicaid beneficiaries were younger (37 vs 50 years of age; P < .001). Medicaid beneficiaries had a significantly longer length of stay (20.9 days; P < .001) when compared to all other patients. They furthermore were more likely to be discharged home or to a skilled nursing facility rather than an acute rehabilitation center. Inpatient charges billed for Medicaid beneficiaries were significantly higher than those of non-Medicaid patients (203,264 USD vs 140,114 USD; P = .015), likely reflecting the increased length of stay while awaiting appropriate disposition. Medicaid patients with SCI in West Virginia had a longer hospital stay, higher charges billed, and were more likely to be discharged home or to a skilled nursing facility rather than an acute rehabilitation center, when compared to non-Medicaid patients. The lack of availability of rehabilitation facilities for Medicaid beneficiaries likely explains this difference.
医疗补助与各种诊断的不良结果有关，例如肺癌、子宫癌和心脏瓣膜手术。与其他保险群体相比，它还与创伤后健康相关的生活质量结果降低有关。在脊髓损伤 (SCI) 中，亚急性治疗的护理可能因付款人身份而异，这可能对结果和护理成本产生影响。对自 2009 年以来所有成年脊髓损伤患者使用机构创伤数据库进行回顾性审查。排除儿科患者。记录了保险类型、种族、住院时间、出院状态（存活/死亡）、出院处置、损伤严重程度评分 (ISS) 和医院计费。确定了 200 名患者。在我们审查期间，整体上有 27.5%的 SCI 患者是医疗补助受益人。ISS 在医疗补助和非医疗补助患者之间相似，但医疗补助受益人更年轻（37 岁与 50 岁；P<0.001）。与所有其他患者相比，医疗补助受益人的住院时间明显更长（20.9 天；P<0.001）。此外，他们更有可能被送回家或到熟练护理机构，而不是急性康复中心。医疗补助受益人的住院费用明显高于非医疗补助患者（203,264 美元与 140,114 美元；P=0.015），这可能反映了在等待适当处置时住院时间的延长。与非医疗补助患者相比，西弗吉尼亚州的 SCI 医疗补助患者的住院时间更长，计费更高，更有可能被送回家或到熟练护理机构，而不是急性康复中心。这可能是因为医疗补助受益人的康复设施缺乏。
