等待保险覆盖：创伤性损伤后的医疗补助登记与急性后期护理使用情况
Awaiting insurance coverage: Medicaid enrollment and post-acute care use after traumatic injury.
作者信息
Haddad Diane N, Hatchimonji Justin S, Eisinger Ella C, Chen Angela T, Chreiman Kristen M, Ramadan Omar I, Morgan Anna U, Delgado M Kit, Martin Niels D, Seamon Mark J, Knowlton Lisa M, Kaufman Elinore J
机构信息
From the Section of Trauma and Acute Care Surgery, Department of Surgery (D.N.H., J.S.H.), University of Chicago, Chicago, Illinois; Perelman School of Medicine (E.C.E., A.T.C., O.I.R., A.U.M., M.K.D., N.D.M., M.J.S., E.J.K.), Division of Trauma, Surgical Critical Care and Emergency Surgery (K.M.C., N.D.M., M.J.S., E.J.K.), University of Pennsylvania, Philadelphia, Pennsylvania; and Department of Surgery (L.M.K.), Stanford University, Stanford, California.
出版信息
J Trauma Acute Care Surg. 2025 Mar 1;98(3):418-424. doi: 10.1097/TA.0000000000004550. Epub 2025 Jan 30.
BACKGROUND
Lack of insurance after traumatic injury is associated with decreased use of postacute care and poor outcomes. Insurance linkage programs enroll eligible patients in Medicaid at the time of an unplanned admission. We hypothesized that Medicaid enrollment would be associated with increased use of postacute care, but also with prolonged hospital length of stay (LOS) while awaiting insurance authorization.
METHODS
We linked trauma registry and EMR data to identify patients ages 18 years to 64 years admitted from 2017 to 2021 to a Level I trauma center. Patients admitted without insurance and retroactively insured (RI) during hospitalization were compared with patients with established Medicaid (MI) and those remaining uninsured (UI). We measured postacute care use including home health care, rehabilitation, and skilled nursing facilities. We tested the association between insurance status and discharge disposition and LOS (primary outcome) using multivariable negative binomial regression. Direct costs were compared between groups.
RESULTS
We compared 494 RI patients to 1706 MI and 148 UI patients. Retroactively insured patients had longer hospitalization (median LOS [interquartile range], 4 days [2-9 days]) than other groups (MI, 4 [2-8] and UI 2 [1-3]), p < 0.001). Retroactively insured patients were more likely to be discharged with home health care and to inpatient rehabilitation than UI patients ( p < 0.001). After adjusting for injury and management characteristics, RI was associated with longer LOS compared with MI for patients discharged to inpatient facilities ( p < 0.001). Median costs for RI patients discharged to a facility were $10,284 higher than MI patients, ranging from $8,582 for Injury Severity Score <9 to $51,883 for Injury Severity Score ≥25.
CONCLUSION
Enrollment in Medicaid after traumatic injury is associated with postacute care use, but the current enrollment process may delay discharge. Streamlining insurance enrollment and permitting discharge with pending application status could reduce unnecessary hospital days, saving costs and improving improve patient experience.
LEVEL OF EVIDENCE
Prognostic and Epidemiological; Level IV.
背景
创伤性损伤后缺乏保险与急性后期护理的使用减少及不良预后相关。保险衔接计划在计划外入院时为符合条件的患者登记医疗补助。我们假设医疗补助登记与急性后期护理的使用增加相关，但也与等待保险授权期间住院时间延长有关。
方法
我们将创伤登记数据和电子病历数据相链接，以识别2017年至2021年期间入住一级创伤中心的18岁至64岁患者。将住院期间无保险但追溯参保（RI）的患者与已参保医疗补助（MI）的患者及仍未参保（UI）的患者进行比较。我们衡量了急性后期护理的使用情况，包括家庭医疗保健、康复治疗和专业护理机构服务。我们使用多变量负二项回归检验保险状态与出院处置及住院时间（主要结局）之间的关联。对各组之间的直接费用进行了比较。
结果
我们将494例RI患者与1706例MI患者及148例UI患者进行了比较。追溯参保患者的住院时间更长（中位住院时间[四分位间距]，4天[2 - 9天]），高于其他组（MI组，4天[2 - 8天]；UI组，2天[1 - 3天]），p < 0.001）。与UI患者相比，追溯参保患者更有可能在出院时接受家庭医疗保健和住院康复治疗（p < 0.001）。在对损伤和管理特征进行调整后，对于出院至住院设施的患者，与MI患者相比，RI患者的住院时间更长（p < 0.001）。出院至某设施的RI患者的中位费用比MI患者高出10,284美元，损伤严重程度评分<9的患者为8,582美元，损伤严重程度评分≥25的患者为51,883美元。
结论
创伤性损伤后参加医疗补助与急性后期护理的使用相关，但当前的参保流程可能会延迟出院。简化保险参保流程并允许在申请状态待定的情况下出院，可以减少不必要的住院天数，节省费用并改善患者体验。
证据级别
预后和流行病学；四级。
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