Abstract
Background
Tertiary referral centers provide specialty and critical care for patients presenting
to hospitals that lack these resources. There is a notion among tertiary centers that
outside hospitals are more likely to transfer uninsured or underinsured patients.
We examined funding status of patients transferred to our tertiary pediatric hospital
for surgical management of appendicitis, hypothesizing that transferred patients were
more likely to have unfavorable coverage.
Materials and methods
The electronic medical record was queried for all cases of laparoscopic appendectomy
at our hospital between 2011 and 2015. Insurance was grouped into three categories:
commercial, Medicaid/Children's Health Insurance Plan, or none. Transferred patients
were compared to patients who presented directly.
Results
A total of 5758 patients underwent laparoscopic appendectomy during the study period,
of which 1683 (29.2%) were transfer patients. Transfer patients were more likely to
be older, with a median age of 10.5 y versus 9.8 y in nontransferred patients (P ≤ 0.0001), and were more likely to be identified as non-Hispanic (50.0% versus 36.5%; P ≤ 0.0001). Insurance coverage was similar between groups. However, subgroup analysis
of the hospitals that most frequently used our transfer services revealed a trend
to transfer a higher proportion of Medicaid/Children's Health Insurance Plan patients.
Conclusions
Overall, pediatric patients transferred for laparoscopic appendectomy had similar
insurance coverage to patients admitted directly, but subgroup analysis shows that
not all centers follow this trend. Transfer patients were more frequently older and
non-Hispanic. This builds upon the existing literature regarding the correlation of
funding and transfer practices and highlights the need for additional research in
this area.
Keywords
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Article info
Publication history
Published online: April 30, 2018
Accepted:
April 3,
2018
Received in revised form:
March 15,
2018
Received:
December 1,
2017
Footnotes
Data statement: Data from this study will not be made available.
Ethics statement: This study was approved by an institutional review board and carried out in compliance with ethical standards for clinical research. Informed consent was deemed not needed by our IRB because of the retrospective nature of this study and the large number of patients. All patient information was deidentified.
Identification
Copyright
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