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Originally published by 2 Minute Medicine® (view original article). Reused on AccessMedicine with permission.

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1. Emergency departments (EDs) that treated higher percentages of patients on Medicaid were more likely to transfer patients, rather than to admit them.

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2. Younger patients, those living in communities with lower median income households, and presentation to nonteaching EDs were other factors associated with increased likelihood of transfer relative to admission.

Study Rundown:

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Systems and guidelines have been developed to help expedite transfer of critically ill pediatric trauma patients to specialized trauma centers. While transfer decision should be based primarily on clinical factors and illness severity, literature from adult patients suggests insurance status may also play a role in decision to transfer to a trauma center from nontrauma centers. Researchers in this study analyzed data from pediatric trauma visits from nontrauma center EDs to characterize the potential relationship between the patient’s insurance status, the insurance status of the ED’s patient population overall, and the decision to transfer or admit a trauma patient,. Results showed that EDs with higher proportions of patients on Medicaid were more likely to transfer rather than admit patients, and were more likely to transfer patients when compared to EDs with lower proportions of Medicaid patients. Younger age, presentation at nonteaching hospitals, and hospitals in communities with lower median household income were also associated with higher transfer rates compared to admission. As a cross-sectional study, this research is limited by an inability to completely account for confounding, such as bed availability and staffing that may have affected decision to transfer. Results of this study suggest the need to further investigate inequities in pediatric trauma visits to ensure patients are transferred appropriately.

In-depth [cross-sectional]:

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This study looked at 9461 pediatric visits (43.1% private insurance, 42.8% Medicaid, 5.7% uninsured) for trauma at 386 nontrauma centers in the United States. Researchers’ primary aim was to determine if patient or ED population insurance status influenced decisions to transfer or admit the patient. Results showed that hospitals with a greater percent of their population having Medicaid insurance were more likely to transfer patients relative to admitting them (OR 1.2 per 10% increase in Medicaid; 95%CI 1.1-1.4). While Medicaid patients overall were slightly more likely to be transferred compared to those with private insurance (76.5% vs 73.5% respectively, p=.001), after adjusting for ED-specific population insurance status, there was no significant difference in transfer rates based on patient insurance (Medicaid OR 1.0, 95%CI 0.8-1.1). Other factors associated with increased transfer rates included age <5 years compared with age >13 years (OR 2.0, 95%CI 1.3-3.1), patients from communities with lower median income housing (income >$63,000 OR 0.5, 95%CI 0.3-0.9) and presentation at a nonteaching hospital (teaching hospital OR 0.2, 95%CI 0.1-0.5) were also more likely to be transferred than to be admitted locally.

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