Association of insurance status with potentially avoidable transfers to an academic emergency department: A retrospective observational study
Abstract Background Interfacility transfers between emergency department (EDs) are common and at times unnecessary. We sought to examine the role of health insurance status with potentially avoidable transfers. Methods We conducted a retrospective observational analysis using hospital electronic adm...
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| Format: | Article |
| Language: | English |
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Elsevier
2021-04-01
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| Series: | Journal of the American College of Emergency Physicians Open |
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| Online Access: | https://doi.org/10.1002/emp2.12385 |
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| author | Megan K. Wright Wu Gong Kimberly Hart Wesley H. Self Michael J. Ward |
| author_facet | Megan K. Wright Wu Gong Kimberly Hart Wesley H. Self Michael J. Ward |
| author_sort | Megan K. Wright |
| collection | DOAJ |
| description | Abstract Background Interfacility transfers between emergency department (EDs) are common and at times unnecessary. We sought to examine the role of health insurance status with potentially avoidable transfers. Methods We conducted a retrospective observational analysis using hospital electronic administrative data of all interfacility ED‐to‐ED transfers to a single, quaternary care adult ED in 2018. We defined a potentially avoidable transfer as an ED‐to‐ED transfer in which the patient did not receive a procedure from a specialist at the receiving hospital and was discharged from the ED or the receiving hospital within 24 hours of arrival. We constructed a multivariable logistic regression model to examine whether insurance status was associated with potentially avoidable transfers among all ED‐to‐ED transfers adjusting for patient demographics, severity, mode of arrival, clinical condition, and rurality. Results Among 7508 transfers, 1862 (25%) were potentially avoidable and were more likely to be uninsured (20% vs 9%). In the multivariable analysis, among ED‐to‐ED transfers for adults aged 18–64 years old who were uninsured (vs any insurance) were significantly more likely to be potentially avoidable (adjusted odds ratio [aOR] 2.1 [1.7, 2.4]) and there is a significant interaction with age. Potentially avoidable transfers increased with younger age, male sex, black (vs white), small rural classification (vs urban), and arrival by ground ambulance (vs flight). Conclusions Potentially avoidable transfers comprised 1 in 4 transfers. Patients who lack insurance were more than twice as likely to be classified as potentially avoidable even after evaluating for confounders and interactions. This effect was most pronounced among younger patients. Further research is needed to explore why uninsured patients are disproportionately more likely to experience potentially avoidable transfers. |
| format | Article |
| id | doaj-art-7a7e831db32346bcbb800427cfe02264 |
| institution | OA Journals |
| issn | 2688-1152 |
| language | English |
| publishDate | 2021-04-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of the American College of Emergency Physicians Open |
| spelling | doaj-art-7a7e831db32346bcbb800427cfe022642025-08-20T02:28:09ZengElsevierJournal of the American College of Emergency Physicians Open2688-11522021-04-0122n/an/a10.1002/emp2.12385Association of insurance status with potentially avoidable transfers to an academic emergency department: A retrospective observational studyMegan K. Wright0Wu Gong1Kimberly Hart2Wesley H. Self3Michael J. Ward4Vanderbilt University School of Medicine Nashville Tennessee USADepartment of Biostatistics Vanderbilt University School of Medicine Nashville Tennessee USADepartment of Biostatistics Vanderbilt University School of Medicine Nashville Tennessee USADepartment of Emergency Medicine Vanderbilt University Medical Center Nashville Tennessee USADepartment of Emergency Medicine Vanderbilt University Medical Center Nashville Tennessee USAAbstract Background Interfacility transfers between emergency department (EDs) are common and at times unnecessary. We sought to examine the role of health insurance status with potentially avoidable transfers. Methods We conducted a retrospective observational analysis using hospital electronic administrative data of all interfacility ED‐to‐ED transfers to a single, quaternary care adult ED in 2018. We defined a potentially avoidable transfer as an ED‐to‐ED transfer in which the patient did not receive a procedure from a specialist at the receiving hospital and was discharged from the ED or the receiving hospital within 24 hours of arrival. We constructed a multivariable logistic regression model to examine whether insurance status was associated with potentially avoidable transfers among all ED‐to‐ED transfers adjusting for patient demographics, severity, mode of arrival, clinical condition, and rurality. Results Among 7508 transfers, 1862 (25%) were potentially avoidable and were more likely to be uninsured (20% vs 9%). In the multivariable analysis, among ED‐to‐ED transfers for adults aged 18–64 years old who were uninsured (vs any insurance) were significantly more likely to be potentially avoidable (adjusted odds ratio [aOR] 2.1 [1.7, 2.4]) and there is a significant interaction with age. Potentially avoidable transfers increased with younger age, male sex, black (vs white), small rural classification (vs urban), and arrival by ground ambulance (vs flight). Conclusions Potentially avoidable transfers comprised 1 in 4 transfers. Patients who lack insurance were more than twice as likely to be classified as potentially avoidable even after evaluating for confounders and interactions. This effect was most pronounced among younger patients. Further research is needed to explore why uninsured patients are disproportionately more likely to experience potentially avoidable transfers.https://doi.org/10.1002/emp2.12385appropriateness of carecare transitionsdecision‐makingemergency careemergency medicineinter‐facility transfer |
| spellingShingle | Megan K. Wright Wu Gong Kimberly Hart Wesley H. Self Michael J. Ward Association of insurance status with potentially avoidable transfers to an academic emergency department: A retrospective observational study Journal of the American College of Emergency Physicians Open appropriateness of care care transitions decision‐making emergency care emergency medicine inter‐facility transfer |
| title | Association of insurance status with potentially avoidable transfers to an academic emergency department: A retrospective observational study |
| title_full | Association of insurance status with potentially avoidable transfers to an academic emergency department: A retrospective observational study |
| title_fullStr | Association of insurance status with potentially avoidable transfers to an academic emergency department: A retrospective observational study |
| title_full_unstemmed | Association of insurance status with potentially avoidable transfers to an academic emergency department: A retrospective observational study |
| title_short | Association of insurance status with potentially avoidable transfers to an academic emergency department: A retrospective observational study |
| title_sort | association of insurance status with potentially avoidable transfers to an academic emergency department a retrospective observational study |
| topic | appropriateness of care care transitions decision‐making emergency care emergency medicine inter‐facility transfer |
| url | https://doi.org/10.1002/emp2.12385 |
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