The extent to which geography explains one of trauma’s troubling trends: Insurance-based differences in appropriate interfacility transfer

The objective of this study was to explore geography's influence on variations in insurance transfer patterns, asking whether differences in distance and travel time by road from NTCs to the nearest level 1 or 2 trauma center alter the effect. As a secondary objective, differences in neighborhood socioeconomic disadvantage were also assessed. METHODS Adults (16–64 years) with major injuries (Injury Severity Score,>15) presenting to NTC emergency departments (EDs) were abstracted from 2007 to 2014 state inpatient/ED claims. Differences in the risk-adjusted odds of admission versus transfer were compared using mixed-effect hierarchical logistic regression and spatial analysis. RESULTS A total of 48,283 adults presenting to 492 NTC EDs were included. Among them, risk-adjusted admission differences based on insurance status exist (e.g., private vs. uninsured odds ratio [95% confidence interval], 1.60 [1.45–1.76]). Spatial analysis revealed significant geographic variation (p
Source: The Journal of Trauma: Injury, Infection, and Critical Care - Category: Orthopaedics Tags: INDEPENDENT SUBMISSIONS Source Type: research