The impact of insurance disparities on long-term burn outcomes: A Burn Model System investigation.

Autor: Mehta A; Division of Trauma, Burn, and Surgical Critical Care, Department of Surgery, Brigham and Women's Hospital, Boston, MA, United States. Electronic address: amehta15@bwh.harvard.edu., Castillo-Angeles M; Division of Trauma, Burn, and Surgical Critical Care, Department of Surgery, Brigham and Women's Hospital, Boston, MA, United States; Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, MA, United States. Electronic address: mcastillo@bwh.harvard.edu., Shepler LJ; Department of Physical Medicine and Rehabilitation, Spaulding Research Institute, Spaulding Rehabilitation Hospital, Boston, MA, United States. Electronic address: lshepler@mgb.org., Carrougher GJ; Department of Surgery, The University of Washington, Seattle, WA, United States. Electronic address: carrough@uw.edu., Gibran NS; Department of Surgery, The University of Washington, Seattle, WA, United States. Electronic address: nicoleg@uw.edu., Stewart BT; Department of Surgery, The University of Washington, Seattle, WA, United States; Harborview Injury Prevention and Research Center, Seattle, WA, United States. Electronic address: barclays@uw.edu., Wolf SE; University of Texas Medical Branch, Galveston, TX, United States. Electronic address: swolf@utmb.edu., Kowalske K; Department of Surgery, The University of Texas Southwestern Medical Center, Dallas-Fort Worth, TX, United States. Electronic address: karen.kowalske@UTSouthwestern.edu., Ryan CM; Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States; Shriners Hospitals for Children's-Boston, Boston, MA, United States. Electronic address: cryan@mgh.harvard.edu., Schneider JC; Department of Physical Medicine and Rehabilitation, Spaulding Research Institute, Spaulding Rehabilitation Hospital, Boston, MA, United States; Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, MA, United States. Electronic address: jcschneider@mgh.harvard.edu.
Jazyk: angličtina
Zdroj: Burns : journal of the International Society for Burn Injuries [Burns] 2024 Sep 05; Vol. 51 (1), pp. 107261. Date of Electronic Publication: 2024 Sep 05.
DOI: 10.1016/j.burns.2024.08.027
Abstrakt: Introduction: Access to healthcare and insurance coverage are associated with quality of life, morbidity, and mortality outcomes. However, most studies have only focused on same-admission and short-term outcomes due to the lack of national longitudinal datalthere are limited data on this topic in the burn literature. Our aim was to determine the effect of insurance status on long-term outcomes in a national sample of burn patients.
Methods: This retrospective study used the longitudinal Burn Model System National Database from January 1997 to December 2020. The inclusion criteria were all adult patients admitted for burn injury from participating sites. Main outcomes were the physical (PCS) and mental (MCS) health component summary scores of the Veterans RAND 12 (VR-12) score at 6, 12, and 24 months after injury. Adjusting for demographic and clinical characteristics, multivariable regression was used to examine the association between insurance status and the outcomes.
Results: A total of 1809 burn patients were included. Most patients had private/commercial insurance (60.42 %), followed by Medicare (13.99 %) and Medicaid (12.77 %). The remaining 13 % were uninsured patients (self-pay or philanthropy). In adjusted analyses, Medicaid insurance was associated with worse MCS at 6 months (Coefficient -4.24, 95 % CI -6.06 - -2.41) and 12 months (Coefficient -3.62, 95 % CI -5.68 - -1.57), and worse PCS at all timepoints, compared to private/commercial insurance. Medicare insurance was associated with worse MCS scores at 12 months (Coefficient -2.86, 95 % CI -5.06 - -0.66) and worse PCS scores at all timepoints.
Conclusion: Having Medicaid and Medicare insurance was significantly associated with a lower health-related quality of life at long-term follow up, even after adjusting for demographics and burn injury severity.
Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
(Copyright © 2024 Elsevier Ltd and ISBI. All rights reserved.)
Databáze: MEDLINE
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