Does Health Insurance Affect the Care of Trauma Patients in Emergency Departments?

OBJECTIVE: The objective of this study was to determine the association of insurance status or lack of coverage with the quality of care that trauma patients receive when seen in the emergency department (ED). METHODS: This is a secondary analysis of ED trauma encounters, as recorded in cross-sectional data from the 2013 National Trauma Data Bank. This data bank is the largest trauma registry in the country, compiled by 805 hospitals including a mix of university, community and non-teaching institutions, ranging from Level I through Level IV trauma centers. Seventeen variables under study included injury severity, primary mode of transport, EMS response time, EMS and ED vital signs and GCS documentation, concurrent alcohol and illicit drug ingestions, ED length of stay, ED disposition, inter-hospital transfer, hospital length of stay, number of ICU days, and hospital disposition. Analysis of variables included differences in each area by payer status, as well as ultimate association with mortality attributed to each variable. RESULTS: The strongest associations were seen with hospital disposition (pseudo r2 of 0.190 and 0.270) and ED disposition (pseudo r2 of 0.114 and 0.152). Other variables that were associated with medium-level effect sizes were EMS and ED GCS scores, hospital length of stay, and number of ICU days. CONCLUSION: This study confirmed there is an existing difference in mortality rates following trauma for patients with different types of health insurance, with especially poor outcomes for uninsured patients. Further research is required on long-term disability, recurrent presentations, and the impact of specific comorbidities