Care Transfers for Patients with Upper Extremity Trauma: Does Insurance Matter?: N/A - Not a clinical study

Abstract

Despite federal legislation, wide variation persists in the referral patterns of upper extremity trauma patients. We sought to understand the differences in transfer rates for patients with upper extremity trauma by hospital trauma center designation, and hypothesized that uninsured and underinsured patients are more likely to be transferred to another facility compared with privately insured patients. Trauma centers are designated by local authorities and verified by the American College of Surgeons. Using the 2012 National Trauma Data Bank, we examined the probability of a patient with isolated upper extremity trauma to be transferred from one center to another. We used multivariable logistic regression to compare risk-adjusted transfer rates for patients with upper extremity injuries by trauma center designation and clustered variance method to adjust for intra-hospital correlation. In 2012, 6,295 adult patients ages 18-64 with isolated upper extremity trauma presented to 477 hospitals. Overall, transfer rates were significantly higher among level III trauma centers (26%) compared with level I (2%) or level II (11%) trauma centers (P < 0.001). Adjusting for patient and hospital characteristics, patients with public insurance were more likely to be transferred from level III trauma centers to another center (OR=1.76, CI: 1.07-2.88) compared with being privately insured. •Underinsured patients with upper extremity trauma injuries were more likely than privately insured patients to be transferred from level III trauma centers.•Lack of transfer guidelines for upper extremity trauma, scarcity and unbalanced distribution of hand and plastic surgeons in level III trauma centers and financial considerations of smaller community hospitals may explain substantial hospital-level variation in upper extremity trauma care in the U.S.•Current regulations may not prevent unnecessary patient transfers based on insurance status among level III trauma centers.•Policy makers may need to provide compensation or incentive to overcome the financial burden of providing care for underinsured patients among smaller and less financially secure hospitals.View Large Image Figure ViewerDownload Hi-res image Download (PPT)