Department of Emergency Medicine, Massachusetts General Hospital, Boston, Mass.
Department of Emergency Medicine, Massachusetts General Hospital, Boston, Mass.
Acad Pediatr. 2021 Jul;21(5):877-884. doi: 10.1016/j.acap.2020.11.010. Epub 2020 Nov 20.
To determine whether frequency of interfacility transfer varied by insurance status among pediatric emergency department (ED) patients. Secondarily, we tested for an association between insurance status and odds of transfer with discharge from the second ED without observation or admission.
We used the 2016 New York State ED and Inpatient Databases to identify all patients <18 years. ED and hospital characteristics were from American Hospital Association and National ED Inventory-USA. Among all ED patients, we calculated the proportion transferred stratified by insurance status (private, public, none). Among ED-to-ED transfers, we identified transfers without subsequent observation or admission, and used hierarchical logistic regression modeling (adjusting for patient and transferring ED/hospital characteristics) to determine whether insurance status was associated with odds of discharge from the second ED without observation or admission.
Of 1,303,575 pediatric ED visits, 6086 (0.5%) were transferred. Transfers were less frequent among patients with public or no insurance. Of 3801 ED-to-ED transfers, 1451 (38%) were without subsequent observation or admission. In bivariate and multivariable analysis, transferred patients with public and with no insurance were less likely to be discharged without observation or admission relative to privately insured patients.
Among ED-to-ED transfers, pediatric patients with public or without insurance were more often kept for observation or admission at the second hospital after transfer. Differences in disease acuity or in providers' perception of follow-up availability may play a role in explaining these patterns. This disparity merits further investigation.
确定在儿科急诊患者中，保险状况是否会影响医疗机构间的转院频率。其次，我们测试了保险状况与在第二家急诊医院未经观察或住院而直接出院的转院几率之间的关联。
我们使用了 2016 年纽约州急诊和住院数据库，以确定所有年龄在 18 岁以下的患者。ED 和医院的特征来自美国医院协会和国家 ED 库存-美国。在所有 ED 患者中，我们按保险状况（私人、公共、无）计算了转院患者的比例。在 ED 到 ED 的转院中，我们确定了没有随后观察或住院的转院患者，并使用分层逻辑回归模型（调整患者和转院 ED/医院特征）来确定保险状况是否与第二家 ED 不经观察或住院而直接出院的几率相关。
在 1303575 例儿科 ED 就诊中，有 6086 例（0.5%）被转院。公共保险或无保险的患者转院的频率较低。在 3801 例 ED 到 ED 的转院中，有 1451 例（38%）没有随后的观察或住院。在单变量和多变量分析中，公共保险和无保险的转院患者与私人保险患者相比，更不可能不经观察或住院而直接出院。
在 ED 到 ED 的转院中，公共保险或无保险的儿科患者在转院后更经常在第二家医院接受观察或住院治疗。疾病严重程度或提供者对随访能力的认知差异可能在解释这些模式方面发挥作用。这种差异值得进一步调查。
