Characteristics of Hand Transfer Patients and Follow-up Care Based on Insurance Status
Ellen Kroin, MD; Sonya Agnew, MD; Sameer Puri, MD; Michael Bednar, MD; Terry Light, MD
Loyola University Medical Center, Maywood, IL
The transfer of patients for hand and microsurgical care from emergency departments (ED) to tertiary care centers is a practice that requires substantial resources. It is often suggested that the patient's insurance status plays a role in likelihood of transfer. Many of these transferred patients may not require immediate surgery in the operating room (OR), but undergo procedures in the ED. They are then discharged with instructions for follow-up care with a hand specialist. Treating surgeons are usually concerned that effective follow-up care is available. This is particularly true for patients with complex hand injuries.
This study analyzed patients with hand injuries or conditions acutely transferred to a university ACS Level 1 trauma center to determine whether there was a correlation between the patient's insurance coverage and the likelihood of outpatient follow-up care with a hand specialist.
After obtaining institutional review board approval, a retrospective chart review was performed in all patients transferred over a 12-month period to a university ACS Level 1 trauma center for the care of hand and microsurgical trauma. Collected data includes timing of patient transfer, demographics, insurance status, diagnosis and co-morbidities, procedures performed, disposition, and status of outpatient follow-up. Statistical analysis was performed to determine whether follow-up with a hand specialist was influenced by insurance status.
Over a 12-month period, a total of 83 hand or microsurgical patients were transferred to our trauma center. Thirty percent of transferred patients were confirmed uninsured while 22% of the patients were confirmed to be insured but out of the institution's network. The uninsured patients were less likely to require admission for acute surgery by a hand specialist (36% uninsured versus 62% insured, p < 0.05). All discharged patients were provided instructions for outpatient follow-up with the institution's hand specialists. However, 36% of the uninsured and 35% of the out-of-network patients who underwent a procedure in the ED or had acute surgery in the OR did not receive follow-up care by the institution's hand specialists, while only 5% of "in network" insured patients (p < 0.05) failed to attend follow-up appointments with medical center surgeons.
This analysis demonstrates that uninsured patients are more likely than insured patients to be transferred with issues that can be treated in the ED. Uninsured and out of network patients are less likely to follow-up with health system surgeons than patients with "in network" insurance.
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