6 Burn Patient Insurance Status Influences Hospital Discharge Disposition Locations

Abstract

Abstract Introduction Post-discharge services, such as outpatient wound care, may affect long term health outcomes and post-recovery quality of life. Access to these services may vary according to insurance status and ability to withstand out-of-pocket expenses. Our objective was to compare discharge location between burn patients who were uninsured, publicly insured, or privately insured at the time of their burn unit admissions. We hypothesized that uninsured patients were more likely to be discharged to locations with fewer wound care resources. Methods A retrospective review from July 1, 2015 to November 1, 2019 was performed at an ABA-verified burn center. All inpatient burn admission patients were identified and categorized according to insurance payer type. Patient and burn characteristics were recorded. The primary outcome was discharge location, and secondary outcomes included readmission and outpatient burn care attendance. Results In total, 284 uninsured, 565 publicly insured and 293 privately insured patients were identified. There were no significant differences in TBSA (P=0.3), presence of full thickness burn (P=0.3), inhalation injury (P=0.3), ICU days (P=0.09), ventilator days (P=0.2), or need for grafting (P=0.1). Uninsured patients were found to be younger (P< 0.0001) and more likely to be male (P=0.03). For primary outcome, uninsured patients were more likely to be discharged without ancillary services (self-care) (80.3% vs. 66.7% vs. 66.9%, P< 0.0001). Publicly insured patients were more likely to receive skilled nursing care (1.1% vs. 6.6% vs. 2.4%, P=0.0007). Privately insured patients were more likely to receive homecare (3.2% vs. 5.8% vs. 10.9%, P=0.0005) or transfer to other institutions for ongoing inpatient care (2.5% vs. 5.1% vs. 11.6%, P< 0.0001). For secondary outcomes, there was no difference in burn unit readmission (P=0.5) while uninsured were more likely to follow up in the same institution’s outpatient burn clinic after discharge (82.4% vs. 72.0% vs. 75.4%, P=0.004). Conclusions Despite no differences in burn injury severity, uninsured patients were less likely to receive post-discharge resources. However, these patients were younger, which may partially explain their disproportionate discharge to self-care. Nevertheless, insured patients have greater access to non-emergent medical resources and a broader range of treatment options. Although there were no significant differences in hospital readmission, the long-term implication to differential post-discharge care is unknown. Additional studies are needed to better elucidate if discrepancies in long-term wound healing or perceived quality of life amongst these populations exist.