Haddad Diane N, Eisinger Ella, Hatchimonji Justin S, Chen Angela T, Ramadan Omar I, Morgan Anna U, Lile Deacon J, Delgado M Kit, Reese James, Seamon Mark J, Martin Niels D, Reilly Patrick M, Knowlton Lisa M, Kaufman Elinore J
From the Division of Trauma (D.N.H., J.S.H., D.J.L., J.R., M.J.S., N.D.M., P.M.R., E.J.K.), Surgical Critical Care and Emergency Surgery, and Perelman School of Medicine (D.N.H., E.E., J.S.H., A.T.C., O.I.R., A.U.M., D.J.L., M.K.D., M.J.S., N.D.M., P.M.R., E.J.K.), University of Pennsylvania, Philadelphia, Pennsylvania; and Department of Surgery (L.M.K.), Stanford University, Stanford, California.
J Trauma Acute Care Surg. 2025 Mar 1;98(3):460-467. doi: 10.1097/TA.0000000000004403. Epub 2024 Sep 3.
Injured patients have high rates of uninsurance, which is associated with worse outcomes. Insurance linkage programs that connect patients to Medicaid coverage can prevent catastrophic costs for patients. Less is known about the long-term impact of insurance enrollment. We examined health care utilization for previously uninsured patients, hypothesizing that newly insured patients postinjury would use health care more than those remaining uninsured.
We linked institutional trauma registry data to the electronic medical record to identify injured patients aged 18 to 64 years from 2017 to 2021. Patients admitted without insurance and then retroactively insured (RI) during hospitalization were compared with patients with preestablished Medicaid (Medicaid insured [MI]) and those remaining uninsured. We compared demographic and injury characteristics and future health care utilization, including hospitalizations, emergency department (ED) visits, and clinic visits, among groups at 30 days and 12 months postinjury. Patient-reported outcomes (PROs) 6 months after injury were compared by group for a subset of patients participating in an ongoing study of long-term PROs.
We compared 494 RI patients with 1,706 MI and 148 uninsured patients. Retroactively insured patients were younger, more likely to have penetrating injuries, and longer hospitalization than other groups. There was a significant increase in ED and clinic visits and hospital admissions at 30 days and 12 months between RI and uninsured patients ( p < 0.001). Using multivariable logistic regression, RI was associated with higher future ED utilization, hospital admissions, and specialist visits at 30 days and 12 months compared with uninsured patients. Of the 265 patients with 6-month PROs, Medicaid coverage was not associated with any significant difference in physical function or anxiety.
Patients enrolled in insurance postinjury are more likely to use health care in the future than patients without insurance, but the downstream effects are less clear. Health insurance is a necessary step but not independently sufficient to optimize care and improve health outcomes.
Prognostic and Epidemiological; Level III.
受伤患者的未参保率很高，这与更差的治疗结果相关。将患者与医疗补助覆盖范围相连接的保险衔接项目可以为患者防止灾难性费用。关于参保的长期影响了解较少。我们研究了既往未参保患者的医疗保健利用情况，假设受伤后新参保的患者比仍未参保的患者会更多地利用医疗保健服务。
我们将机构创伤登记数据与电子病历相链接，以识别2017年至2021年期间年龄在18至64岁的受伤患者。将住院时无保险随后追溯参保（RI）的患者与已参加医疗补助（医疗补助参保[MI]）的患者以及仍未参保的患者进行比较。我们比较了各组在受伤后30天和12个月时的人口统计学和损伤特征以及未来的医疗保健利用情况，包括住院、急诊就诊和门诊就诊。对参与一项正在进行的长期患者报告结局（PRO）研究的一部分患者，比较了受伤后6个月时各组的患者报告结局。
我们将494例RI患者与1706例MI患者和148例未参保患者进行了比较。追溯参保患者比其他组更年轻，更有可能遭受穿透性损伤，住院时间更长。RI患者与未参保患者相比，在30天和12个月时急诊和门诊就诊以及住院次数有显著增加（p<0.001）。使用多变量逻辑回归分析，与未参保患者相比，RI患者在30天和12个月时未来急诊利用、住院和专科就诊的可能性更高。在265例有6个月PRO的患者中，医疗补助覆盖与身体功能或焦虑方面的任何显著差异均无关联。
受伤后参保的患者未来比未参保患者更有可能利用医疗保健服务，但下游影响尚不清楚。医疗保险是必要步骤，但不足以独立地优化治疗并改善治疗结果。
预后和流行病学；三级。
