The effect of discharge destination and primary insurance provider on hospital discharge delays among patients with traumatic brain injury: a multicenter study of 1,543 patients.
Insurance
Patient discharge
Traumatic brain injury
Journal
Patient safety in surgery
ISSN: 1754-9493
Titre abrégé: Patient Saf Surg
Pays: England
ID NLM: 101319176
Informations de publication
Date de publication:
2020
2020
Historique:
received:
15
11
2019
accepted:
30
12
2019
entrez:
9
1
2020
pubmed:
9
1
2020
medline:
9
1
2020
Statut:
epublish
Résumé
Hospital length of stay (HLOS) is a commonly used measure of hospital quality and is influenced by clinical and non-clinical factors. To reduce HLOS, it is key to identify factors placing patients at increased risk of lengthy HLOS and discharge delays. This was a retrospective cohort study of patients age ≥ 18 admitted to four level 1 trauma centers between 1/1/2015 and 3/31/2018 with traumatic brain injury (TBI). The primary outcome was discharge delay, defined as discharge ≥24 h after case management notes indicated the patient was ready for discharge. The independent variables of interest were primary insurance provider and discharge destination. Chi-square, Fisher exact, and unadjusted and adjusted logistic regression analyses were used to assess associations between discharge delay and the two primary independent variables, as well as other patient demographic and clinical characteristics. Complications developing during the delay period were also examined. A total of 1543 patients with TBI were included. The median age was 61 years, and the median HLOS was 5 days. Approximately half of patients were discharged home (54%). The most common insurance providers were Medicare (35%) and commercial/private (35%). Two-hundred ten (14%) patients experienced a discharge delay. The median delay period was 3 days, and the most common reasons for delay were insurance authorization (52%) and lack of accepting bed (41%). Compared to being discharged home, patients discharged to a skilled nursing facility (adjusted odds ratio (AOR) = 10.35) or intermediate care facility (AOR = 10.64) had the highest odds of discharge delay. Compared to Medicare patients, uninsured/self-pay patients (AOR = 2.98) and those with Medicaid (AOR = 2.83) or commercial/private insurance (AOR = 2.22) had higher odds of delay. Thirty-two patients (15% of those delayed) experienced at least one complication during the delay, some of which were clinically severe. A substantial portion of TBI patients in this study experienced discharge delays, and discharge destination and primary insurance provider were significant drivers of these delays. Evaluation of a facility's quality of care should consider the specific causes of these delays.
Sections du résumé
BACKGROUND
BACKGROUND
Hospital length of stay (HLOS) is a commonly used measure of hospital quality and is influenced by clinical and non-clinical factors. To reduce HLOS, it is key to identify factors placing patients at increased risk of lengthy HLOS and discharge delays.
METHODS
METHODS
This was a retrospective cohort study of patients age ≥ 18 admitted to four level 1 trauma centers between 1/1/2015 and 3/31/2018 with traumatic brain injury (TBI). The primary outcome was discharge delay, defined as discharge ≥24 h after case management notes indicated the patient was ready for discharge. The independent variables of interest were primary insurance provider and discharge destination. Chi-square, Fisher exact, and unadjusted and adjusted logistic regression analyses were used to assess associations between discharge delay and the two primary independent variables, as well as other patient demographic and clinical characteristics. Complications developing during the delay period were also examined.
RESULTS
RESULTS
A total of 1543 patients with TBI were included. The median age was 61 years, and the median HLOS was 5 days. Approximately half of patients were discharged home (54%). The most common insurance providers were Medicare (35%) and commercial/private (35%). Two-hundred ten (14%) patients experienced a discharge delay. The median delay period was 3 days, and the most common reasons for delay were insurance authorization (52%) and lack of accepting bed (41%). Compared to being discharged home, patients discharged to a skilled nursing facility (adjusted odds ratio (AOR) = 10.35) or intermediate care facility (AOR = 10.64) had the highest odds of discharge delay. Compared to Medicare patients, uninsured/self-pay patients (AOR = 2.98) and those with Medicaid (AOR = 2.83) or commercial/private insurance (AOR = 2.22) had higher odds of delay. Thirty-two patients (15% of those delayed) experienced at least one complication during the delay, some of which were clinically severe.
CONCLUSIONS
CONCLUSIONS
A substantial portion of TBI patients in this study experienced discharge delays, and discharge destination and primary insurance provider were significant drivers of these delays. Evaluation of a facility's quality of care should consider the specific causes of these delays.
Identifiants
pubmed: 31911820
doi: 10.1186/s13037-019-0227-z
pii: 227
pmc: PMC6945617
doi:
Types de publication
Journal Article
Langues
eng
Pagination
2Informations de copyright
© The Author(s). 2020.
Déclaration de conflit d'intérêts
Competing interestsThe authors declare that they have no competing interests.
Références
Stroke. 2011 Nov;42(11):3214-8
pubmed: 21868737
JAMA Surg. 2013 Oct;148(10):956-61
pubmed: 23965602
Acad Emerg Med. 2010 Feb;17(2):142-50
pubmed: 20370743
J Stroke Cerebrovasc Dis. 2017 Apr;26(4):711-716
pubmed: 28238528
Am Surg. 2007 Dec;73(12):1269-74
pubmed: 18186388
J Trauma. 2005 Jan;58(1):121-5
pubmed: 15674162
Arch Surg. 2007 May;142(5):461-5; discussion 465-6
pubmed: 17515488
Trauma Mon. 2016 Feb 06;21(1):e20349
pubmed: 27218048
Health Serv Res. 1988 Dec;23(5):619-47
pubmed: 3060449
J Hosp Infect. 2016 May;93(1):92-9
pubmed: 26944900
J Infect Public Health. 2014 Jul-Aug;7(4):339-44
pubmed: 24861643
Inj Prev. 2010 Aug;16(4):254-60
pubmed: 20587811