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Pediatric patients with Medicaid more likely to be transferred to trauma center

SAN FRANCISCO — Acutely injured pediatric patients with Medicaid are more likely to be transferred from an ED to a designated trauma center than patients with private insurance, according to data presented at the 2016 AAP National Conference and Exhibition.

The researchers further concluded the results underscore concerns regarding differences in the quality and delivery of care to injured children based on insurance coverage.

Yunru Huang

“Our findings reinforce ongoing concerns about inequities in the delivery of care and adherence to the American College of Surgeon’s Committee on trauma guidelines and the Emergency Medical Treatment and Active Labor Act requiring hospitals to make decisions on patients’ transfer or admission independent of their insurance status,” Yunru Huang, a PhD candidate at the University of California-Davis School of Medicine, told Healio Family Medicine. “Hospitals and physicians should be monitored to identify when injured children are treated differently because of their insurance status.”

To examine whether children with acute injuries presenting to a non-designated ED would be more or less likely to be transferred to designated trauma centers depending on their insurance type, the researchers drew data from 950 hospitals in 30 states included in the Healthcare Cost and Utilization Project 2012 Nationwide Emergency Department Sample. Researchers included pediatric trauma patients younger than 17 years who received care in non-designated EDs and were admitted locally or transferred to a trauma center.

Insurance status categories included Medicaid, uninsured, private or “other insurance.” The researchers used multivariate logistic regression models to adjust for confounders, including the Injury Severity Score, and incorporated representative weights to assess associations.

According to the researchers, 9,461 pediatric ED events at non-trauma centers met the inclusion requirements. Older age and male sex were associated with greater odds of the patients being transferred relative to admission, the researchers said. After adjusting for severity of injury and confounders, patients with Medicaid were more likely to be transferred compared to those with private insurance (OR = 1.25; 95% CI, 1.03, 1.53). The likelihood of a patient being transferred was similar among patients who were uninsured (OR = 1.38; 95% CI, 0.97, 1.97) or had other insurance types (OR = 1.03; 95% CI, 0.72, 1.46), the researchers said. – by Jason Laday

Reference:

Huang Y, et al. Association between insurance and transfer of injured children from emergency departments. 2016 AAP National Conference and Exhibition; San Francisco, Oct. 21, 2016.

Disclosure: The researchers report no relevant financial disclosures.