77 Insurance Status Plays a Role in Burn Patient Disposition Following Burn Injury

Abstract

Abstract Introduction According to the Emergency Medical Treatment and Labor Act (EMTALA), patient insurance status has no role in stabilization and treatment of patients brought into the emergency department. However, uninsured patients with burn injuries are more likely than insured patients to face early hospital discharge, and less likely to receive care in skilled facilities for post-hospital rehabilitation. Following trauma, insured patients are more likely to have longer hospital lengths of stay (LOS) compared to uninsured patients, resulting in a loss of clinical equipoise. The purpose of this study was to evaluate whether insurance status affects morbidity, mortality, LOS, and post-discharge care for patients with burn injuries. We hypothesized that insured patients would experience fewer complications but would more frequently be referred to skilled facilities for extended post-discharge care. Methods We retrospectively queried our prospectively collected burn database for all patients suffering from burn trauma and admitted to our burn facility from July 2015-December 2015. Patients under the age of 18 years and those without documented insurance status were excluded. Our primary outcome was any complication. Secondary outcomes included LOS, ICU days, mortality, and disposition. Chi-square and multivariate logistic regression analyses were performed using Stata. Results A total of 451 patients were included (74% male, median age 51 years, TBSA 20% ± 1.1, 27% were uninsured). Univariate analysis showed that uninsured patients were less likely to have complications following burn injury, as well as less likely to have any comorbidities (28.5% vs. 40.6%, p=0.02; 55.3% vs. 72.3%, p=0.001, respectively). After controlling for confounding variables (Baux score, comorbidities, gender, and smoking) we found there was no association between complications and insurance status (OR 1.45, 95% CI 0.91–2.33). Using the same regression model, we secondarily found that there was a significant association between disposition after hospital admission and insurance status (OR 1.94, 95% CI 1.04–3.62) as well as an association between mortality and insurance status (OR 0.35, 95% CI 0.17–0.72). Conclusions At our institution, insurance status for burn patients was not associated with differences in length of stay or complications. Despite this, insured patients were more likely to be discharged to skilled facilities and less likely to die from burn injury. Disparate outcomes between insured and un-insured burn patients remain a significant concern, and more studies are needed to understand underlying etiologies.