In a study that focused on Medicare coverage, insurance-related differences in treatment were found during the discharge planning process for otherwise similar patients with trauma, researchers report. There was “little evidence that health systems modified treatment decisions based on patients’ coverage,” the investigators conclude.
The study analyzed the records for 1.6 million trauma encounters among adults aged 50–79 years who received care from 2007 to 2017 at level I and level II trauma centers that contribute to the U.S. American College of Surgeons’ National Trauma Data Bank. The main outcome measure was change in health insurance coverage, complications, in-hospital mortality, processes of care in the trauma bay, treatment patterns during hospital admission, and discharge locations at age 65 years.
“At age 65, a discontinuous increase of 9.6 percentage points (95% confidence interval 9.1 to 10.1) was observed in the share of patients with health insurance coverage through Medicare at age 65 years,” the authors write. “Entry to Medicare at age 65 was also associated with a decrease in length of hospital stay for each encounter, of 0.33 days (95% confidence interval −0.42 to −0.24 days), or nearly 5%), which coincided with an increase in discharges to nursing homes (1.56 percentage points, 95% confidence interval 0.94 to 2.16 percentage points) and transfers to other inpatient facilities (0.57 percentage points, 0.33 to 0.80 percentage points), and a large decrease in discharges to home (1.99 percentage points, −2.73 to −1.27 percentage points). Relatively small (or no) changes were observed in treatment patterns during the patients’ hospital admission, including no changes in potentially life saving treatments (eg, blood transfusions) or mortality.”