Research Fellow, Department of Orthopaedic Surgery, University of Alabama, Birmingham, Birmingham, AL.
Resident Physcian, Department of Orthopaedic Surgery, University of Alabama, Birmingham, Birmingham, AL.
J Foot Ankle Surg. 2021 May-Jun;60(3):520-522. doi: 10.1053/j.jfas.2020.10.006. Epub 2020 Oct 7.
Delayed access to care for patients with ankle fractures may increase risk of complications, particularly if surgical management is warranted. Medicaid is a state and federal insurance program in place for those with low income, which has previously been associated with delayed access to care among patients with ACL tears and total hip arthroplasties. The purpose of this study is to assess whether patient insurance status affects access to care for ankle fracture patients, using data from a single institution. A retrospective cohort study (N = 311 patients)was performed on individuals that underwent open reduction and internal fixation for an ankle fracture between years 01/2008 and 12/2018. Patients with polytraumatic injuries, open injuries, Medicare, no insurance, indigent/charity insurance, self-pay, or whose insurance information was not available were excluded. Time from date of injury to date of surgery, injury to first visit, and first visit to surgery was compared between patients with private insurance and Medicaid. Average time from injury to first appointment was 1.2 days and 6.2 days for privately insured and Medicaid patients, respectively (p < .001). Average time from injury to surgery was 8.3 days and 16.1 days for privately insured and Medicaid patients, respectively (p < .001). Patients enrolled in Medicaid have significantly delayed access to care compared to those with private insurance. For ankle fracture patients this is a critical healing time, and delayed care may result in increased costs, increased utilization of healthcare resources, higher complication rates, and poorer patient outcomes.
患者踝关节骨折就诊延迟可能会增加并发症的风险，特别是如果需要手术治疗。医疗补助是为低收入人群提供的一项州和联邦保险计划，先前的研究表明，医疗补助与 ACL 撕裂和全髋关节置换术患者的就诊延迟有关。本研究的目的是使用单一机构的数据评估患者的保险状况是否会影响踝关节骨折患者的就诊机会。对 2008 年 1 月至 2018 年 12 月期间接受切开复位内固定术治疗的踝关节骨折患者进行了回顾性队列研究（N = 311 例）。排除了合并多发伤、开放性损伤、医疗保险、无保险、贫困/慈善保险、自费/自付或无法获得保险信息的患者。比较了私人保险和医疗补助患者的受伤至手术日期、受伤至首次就诊日期和首次就诊至手术日期。私人保险和医疗补助患者从受伤到首次就诊的平均时间分别为 1.2 天和 6.2 天（p <.001）。私人保险和医疗补助患者从受伤到手术的平均时间分别为 8.3 天和 16.1 天（p <.001）。与私人保险患者相比，参加医疗补助的患者就诊明显延迟。对于踝关节骨折患者，这是一个关键的愈合时间，延迟治疗可能会导致成本增加、医疗资源利用增加、并发症发生率增加和患者预后较差。
