Division of Plastic Surgery, University of Southern California, Los Angeles, California, USA.
Los Angeles County Department of Health Services, Los Angeles, California, USA.
J Burn Care Res. 2023 May 2;44(3):495-500. doi: 10.1093/jbcr/irab124.
Postdischarge services, such as outpatient wound care, may affect long-term health outcomes and postrecovery quality-of-life. Access to these services may vary according to insurance status and ability to cover out-of-pocket expenses. Our objective was to compare discharge location between burn patients who were uninsured, publicly insured, and privately insured at the time of their burn unit admissions. A retrospective review from July 1, 2015 to November 1, 2019 was performed at an American Burn Association-verified burn center. All admitted burn patients 18 years and older were identified and categorized according to insurance payer type. The primary outcome was discharge location, and secondary outcomes included readmission and outpatient burn care attendance. In total, 284 uninsured, 565 publicly insured, and 293 privately insured patients were identified. There were no significant differences in TBSA (P = .3), inhalation injury (P = .3), intensive care unit days (P = .09), or need for skin grafting (P = .1) between the three groups. For primary outcome, uninsured patients were more likely to be discharged without ancillary services (P < .0001) compared to both publicly and privately insured. Publicly insured patients were more likely to receive skilled nursing care (P = .0007). Privately insured patients were more likely to receive homecare (P = .0005) or transfer for ongoing inpatient care (P < .0001). There was no difference in burn unit readmission rates (P = .5). The uninsured were more likely to follow up with outpatient burn clinic after discharge (P = .004). Uninsured patients were less likely to receive postdischarge resources. Uninsured patients received fewer postdischarge wound care resources which could result in suboptimal long-term results, and diminished return to preinjury functional status. Given the impact of insurance status on discharge location and resources, efforts to increase access for uninsured patients to postdischarge resources will ensure greater healthcare equity and improve quality of comprehensive care regardless of insurance status.
出院后服务，如门诊伤口护理，可能会影响长期健康结果和康复后生活质量。这些服务的可及性可能因保险状况和支付自付费用的能力而异。我们的目的是比较在烧伤单位入院时无保险、公共保险和私人保险的烧伤患者的出院地点。对一家美国烧伤协会认证的烧伤中心于 2015 年 7 月 1 日至 2019 年 11 月 1 日进行的回顾性研究。确定并根据保险支付者类型对所有 18 岁及以上的入院烧伤患者进行分类。主要结果是出院地点，次要结果包括再入院和门诊烧伤护理就诊。总共有 284 名无保险、565 名公共保险和 293 名私人保险患者被确定。三组之间 TBSA（P =.3）、吸入性损伤（P =.3）、重症监护病房天数（P =.09）或植皮需求（P =.1）无显著差异。对于主要结果，与公共保险和私人保险相比，无保险患者更有可能在没有辅助服务的情况下出院（P <.0001）。公共保险患者更有可能接受熟练护理（P =.0007）。私人保险患者更有可能接受家庭护理（P =.0005）或转至持续住院治疗（P <.0001）。烧伤单位再入院率无差异（P =.5）。无保险患者在出院后更有可能到门诊烧伤诊所就诊（P =.004）。无保险患者获得的出院后资源较少。无保险患者接受的出院后伤口护理资源较少，可能导致长期结果不理想，并降低恢复到受伤前的功能状态。鉴于保险状况对出院地点和资源的影响，努力增加无保险患者获得出院后资源的机会将确保更大的医疗保健公平性，并提高综合护理质量，无论保险状况如何。
