The Relationship of Trauma Readmissions and Insurance Status: Does it Matter?




Shalwani, Anil A.


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Purpose: Unplanned hospital readmissions in trauma patients, in relation to insurance status, are under-explored. This study tests the hypothesis that patients readmitted following a traumatic injury are publically insured and over the age of 65 years. Methods: The data in this study were collected retrospectively from an urban, Level I trauma center between January 1, 2003 and June 30, 2015 and contains patient encounters obtained from Dallas-Fort Worth Hospital Council (DFWHC). A binary logistic regression of the dichotomous dependent variable readmission was performed (ρ [less than] 0.05, 95% confidence interval). Results: A total of 28,979 encounters and 21,231 patients were analyzed. The overall rate of any readmission was 42.2%. Of the 28,979 total encounters, 21,556 encounters consisted of individuals aged 64 years or younger and 7,423 encounters consisted of individuals aged 65 years or older, with readmission rates of 35.2% and 62.6%, respectively (ρ [less than] 0.000). Of the readmission encounters, 41% were insured through Medicare, 22% were uninsured, 28% were privately insured, and 9% were insured through Medicaid. Falls were found to be the number one cause (29%) of readmissions in this population, with severe sepsis as the number one comorbidity (OR=9.46, ρ [less than] 0.000). Conclusion: This study confirmed our hypothesis and found that older individuals, specifically over the age of 65 years, with Medicare insurance are more likely to be readmitted following traumatic injury and characterized by their vulnerability and tendency to fall. This data highlights the need for hospital-centered education focused towards the elderly population.