Does Insurance Status Affect Continuity of Care for Ambulatory Patients with Operative Fractures?

Wolinsky, Philip; Kim, Sunny; Quackenbush, Michael
April 2011
Journal of Bone & Joint Surgery, American Volume;4/6/2011, Vol. 93-A Issue 7, p680
Academic Journal
Background: We compared insurance status among three groups of ambulatory patients with an operatively treated fracture of the distal part of the radius or of the ankle, in order to determine if insurance status affected continuity of care. The patients were categorized as having received initial care at our institution, having received initial care elsewhere with an identifiable reason for transfer to a tertiary care center, or having received initial care elsewhere with no identifiable reason for transfer. Methods: We conducted a retrospective review of 697 patients with an operatively treated distal radial fracture or ankle fracture who had received their definitive treatment at a level-I trauma center. Demographic data, the mechanism of injury, the insurance type, and the location of the initial care were recorded. Results: The proportion of uninsured or underinsured patients in the group that had had their initial treatment at our trauma center was similar to that in the group that had had a specific reason to seek definitive care with us (64% and 63%, p <0.832). However, the proportion of uninsured or underinsured patients was significantly larger in the group that had not received initial care from us and had no specific reason to receive definitive care from us (82% vs. 63%, p < 0.001). With other variables held constant, the odds of being underinsured or uninsured were 2.53 times greater for the patients initially treated elsewhere who had no specific reason to receive definitive treatment from us. Conclusions: These results suggest that nonmedical reasons play a role in determining where ambulatory patients with fractures requiring operative treatment are able to receive definitive care. Patients without specific medical or nonmedical reasons to receive definitive care at our center were significantly more likely to be uninsured or underinsured.


Related Articles

  • Needs of Ambulatory Patients With Cancer Who Visited Outpatient Units in Japanese Hospitals. Mizuno, Michiyo; Arita, Hiromi; Kakuta, Miho // Oncology Nursing Forum;May2005, Vol. 32 Issue 3, p544 

    Purpose/Objectives: To document the domains and properties of the self-reported needs of ambulatory patients with cancer. Design: Descriptive. Setting: Outpatient units in three general hospitals in Japan. Sample: 139 ambulatory patients with cancer. Methods: The data were collected using...

  • Common Symptoms in Ambulatory Care: Incidence, Evaluation, Therapy, and Outcome.  // JAMA: Journal of the American Medical Association;9/1/89, Vol. 262 Issue 9, p1236 

    Discusses an abstract of the article, entitled 'Common symptoms in ambulatory care: Incidence, evaluation, therapy and outcome,' by Kurt Kroenke and colleagues at the Department of Medicine, Uniformed Services University of Health Sciences, and published in the American Journal of Medicine'.

  • Pattern of co-prescription of silymarin and antidiabetics in outpatient, a population based study. Chan, Agnes L. F.; Leung, Henry W. C.; Tsair-Wei Chien; Shun-Jin Lin // Journal of Medicinal Food Plants;Jul2009, Vol. 1 Issue 2, p1 

    The aim of this study was to analyze the trend of combined use of silymarin and hypoglycemic drugs (anti-diabetics) by elderly outpatient in 7-year period in Taiwan and assess whether the trends may be in line with the preliminary positive outcome. A systematic review analysis was performed to...

  • Neonatal jaundice is a risk factor for childhood allergic rhinitis: A retrospective cohort study. Sun, Hai-Lun; Lue, Ko-Huang; Ku, Min-Sho // American Journal of Rhinology & Allergy;May/Jun2013, Vol. 27 Issue 3, p192 

    Background: This study evaluates the association between neonatal jaundice and childhood allergic rhinitis (AR). Methods: Eleven thousand three hundred twenty-eight children were collected from the National Health Insurance Research Database in Taiwan. Their claims data were evaluated from birth...

  • THE USE OF RESPONSES TO A SINGLE ITEM VERSUS MULTIPLE ITEMS IN A CLUSTER ANALYSIS TO IDENTIFY SUBGROUPS OF PATIENTS WITH DIFFERENT SYMPTOM EXPERIENCES. Kim, Jung Eun Esther; Miaskowski, Christine; Dodd, Marylin; Lee, Katherine; West, Claudia; Cooper, Bruce // Oncology Nursing Forum;Jan2007, Vol. 34 Issue 1, p192 

    Our previous work demonstrated that oncology outpatients could be characterized, using cluster analysis, into 4 distinct subgroups based on their experiences with 4 highly prevalent symptoms (i.e., pain, fatigue, sleep disturbances, depression). Importantly, patients who reported high levels of...

  • Antibiotic prescribing and expenditures in outpatient paediatrics in Greece, 2010-13. Kourlaba, Georgia; Kourkouni, Eleni; Spyridis, Nikos; Gerber, Jeffrey S.; Kopsidas, John; Mougkou, Katerina; Lourida, Athanasia; Zaoutis, Theoklis E. // Journal of Antimicrobial Chemotherapy (JAC);Aug2015, Vol. 70 Issue 8, p2405 

    Objectives The objectives of this study were to provide a nationally representative analysis of antibiotic prescribing in outpatient paediatrics and to assess overall and class-specific antibiotic costs in Greece. Methods Data on antibiotic prescriptions for patients aged ≤19 years old...

  • Evolving accreditation: Rise of ACOs prompts group to expand services beyond ambulatory care. McKinney, Maureen // Modern Healthcare;8/20/2012, Vol. 42 Issue 34, p30 

    The article discusses the impacts of the rapid growth of accountable care organizations and other payment models in the accreditation sector in the U.S. It cites the plans by the Illinois-based Accreditation Association for Ambulatory Health Care (AAAHC) to establish a new accreditation scheme...

  • Effect on institutional revenue of clinical pharmacy services in an ambulatory care clinic.  // American Journal of Health-System Pharmacy;3/15/2013, Vol. 70 Issue 6, p482 

    The article discusses a retrospective evaluation of anticipated revenue and relative value units (RVUs) which compared the revenue differences between physicians only and physician-pharmacist collaborative clinic models. The evaluation was used to measure the average reimbursement and average...

  • Case Management and the Continuum of Care. Brueckner, Gerry; Glover, Talar // Outpatient Case Management;1994, p95 

    Investigates how case management provides a communication link between the inpatient and outpatient providers involved in any individual patient's continuum of care. Examples of service line integration; How comprehensive care plans work; Discussion on case management alternatives and...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics