Admit or Transfer? The Role of Insurance in High-Transfer-Rate Medical Conditions in the Emergency Department
| dc.contributor.author | Kindermann, Dana R. | |
| dc.contributor.author | Mutter, Ryan L. | |
| dc.contributor.author | Cartwright-Smith, Lara | |
| dc.contributor.author | Rosenbaum, Sara | |
| dc.contributor.author | Pines, Jesse M. | |
| dc.date.accessioned | 2021-07-15T16:06:17Z | |
| dc.date.available | 2021-07-15T16:06:17Z | |
| dc.date.issued | 2013-12-16 | |
| dc.description.abstract | Study objective We study the association of payer status with odds of transfer compared with admission from the emergency department (ED) for multiple diagnoses with a high percentage of transfers. Methods This was a retrospective study of adult ED encounters using the Healthcare Cost and Utilization Project 2010 Nationwide Emergency Department Sample. We used the Clinical Classification Software to identify disease categories with 5% or more encounters resulting in transfer (27 categories; 3.7 million encounters based on survey weights). We sorted encounters by condition into 12 groups according to expected medical or surgical specialist needs. We used logistic regression to assess the role of payer status on odds of transfer compared with admission and report adjusted odds ratios (ORs). Results Among high-transfer conditions in 2010, uninsured patients had double the odds of transfer compared with privately insured patients (OR 2.12; 95% confidence interval [CI] 1.72 to 2.62). Medicaid patients were also more likely to be transferred (OR 1.2; 95% CI 1.04 to 1.38). Uninsured patients had higher odds of transfer in all specialist categories (significant in 9 of 12). The categories with the highest odds of transfer for the uninsured included nephrology (OR 2.44; 95% CI 1.07 to 5.55), psychiatry (OR 2.26; 95% CI 1.65 to 3.25), and hematology-oncology (OR 2.21; 95% CI 1.50 to 3.25); the highest for Medicaid were general surgery (OR 1.61; 95% CI 1.09 to 1.83), hematology-oncology (OR 1.55; 95% CI 1.05 to 2.30), and vascular surgery (OR 1.55; 95% CI 1.02 to 2.28). Conclusion Insurance status appears to play a role in ED disposition (transfer versus admission) for many high-transfer conditions. | en_US |
| dc.description.sponsorship | By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). The authors have stated that no such relationships exist. | en_US |
| dc.description.uri | https://www.annemergmed.com/article/S0196-0644(13)01639-9/fulltext#%20 | en_US |
| dc.format.extent | 19 pages | en_US |
| dc.genre | journal articles | en_US |
| dc.identifier | doi:10.13016/m24oqb-gnh8 | |
| dc.identifier.citation | Kindermann, Dana R. et al.; Admit or Transfer? The Role of Insurance in High-Transfer-Rate Medical Conditions in the Emergency Department; Annals of Emergency Medicine, 63, 5, p 561-571, 16 December, 2013; https://doi.org/10.1016/j.annemergmed.2013.11.019 | en_US |
| dc.identifier.uri | https://doi.org/10.1016/j.annemergmed.2013.11.019 | |
| dc.identifier.uri | http://hdl.handle.net/11603/21933 | |
| dc.language.iso | en_US | en_US |
| dc.publisher | Elsevier | en_US |
| dc.relation.isAvailableAt | The University of Maryland, Baltimore County (UMBC) | |
| dc.relation.ispartof | UMBC School of Public Policy Collection | |
| dc.rights | This item is likely protected under Title 17 of the U.S. Copyright Law. Unless on a Creative Commons license, for uses protected by Copyright Law, contact the copyright holder or the author. | |
| dc.rights | Public Domain Mark 1.0 | * |
| dc.rights | This work was written as part of one of the author's official duties as an Employee of the United States Government and is therefore a work of the United States Government. In accordance with 17 U.S.C. 105, no copyright protection is available for such works under U.S. Law. | |
| dc.rights.uri | http://creativecommons.org/publicdomain/mark/1.0/ | * |
| dc.title | Admit or Transfer? The Role of Insurance in High-Transfer-Rate Medical Conditions in the Emergency Department | en_US |
| dc.type | Text | en_US |