Editor's choiceThe Effects of Medicaid Expansion on Triage and Regional Transfer After Upper-Extremity Trauma
Section snippets
Materials and Methods
The sole legislatively designated upper-extremity trauma center for Maryland, although not a level I or II trauma center, accepts severely injured isolated hand and upper-extremity trauma patients directly triaged from the field via the Maryland Institute for Emergency Medical Services Systems,20 as well as transfers from hospitals throughout the Mid-Atlantic region. We obtained institutional review board approval and performed a retrospective study of all isolated hand and upper-extremity
Results
Table 1 lists basic characteristics of the study cohort (N = 12,009). Overall, patients were predominantly male (72%) and white (51%), and were most often treated for blunt or crush injuries (65%). In total, over all 8 years, 20% had Medicaid and 27% had no insurance. Thirty percent of patients traveled over 25 miles to obtain treatment and 47% qualified as having an appropriate indication for emergent hand surgery specialist care. Twenty-five percent of all patients were transferred to our
Discussion
We found a significant increase in the probability of Medicaid coverage and a concomitant decrease in the probability of self-pay in upper-extremity trauma patients after Medicaid expansion. However, we did not find an increase in the probability of appropriateness, as we hypothesized, in transfer or non-transfer patients. Notably, after Medicaid expansion there was a decrease in appropriateness among non-transfer patients regardless of insurance status. The self-pay group consistently
Acknowledgments
This study was funded by the Raymond M. Curtis Research Foundation, the Curtis National Hand Center, Baltimore, Maryland.
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Cited by (7)
Health Disparities in Hand and Upper Extremity Surgery: A Scoping Review
2023, Journal of Hand SurgeryHand Call Practices and Satisfaction: Survey Results From Hand Surgeons in the United States
2022, Journal of Hand SurgeryCitation Excerpt :Another study comparing emergent hand trauma management before and after Medicaid expansion in Maryland found no difference in the “appropriateness of transfers” or the distance traveled for specialized care despite increased insurance coverage following Medicaid expansion. The results suggested that the reasons for the transfer of care were independent of insurance coverage.18 The disparities in hand surgeon on-call availability might be, in part, related to unequal distribution of hand surgeons across the US, with underserved areas including those with a low per-capita income or low density of fellowships.19
The Curtis Hand Injury Matrix Score: Determining the Need for Specialized Upper Extremity Care
2022, Journal of Hand SurgeryCitation Excerpt :The factors influencing transfer decisions have been widely studied. Although injury complexity is believed to be the primary reason, many studies have found that inappropriate transfers are also driven by reimbursement concerns or insurance status.3–8,10,11 The CHIM scoring system is not intended to standardize transfer protocols and does not account for the complexity of a transfer decision.
CORR Synthesis: What Triage Recommendations Are Available for Emergent or Urgent Musculoskeletal Conditions?
2022, Clinical Orthopaedics and Related ResearchThe Affordable Care Act and Its Impact on Plastic and Gender-Affirmation Surgery
2021, Plastic and Reconstructive SurgeryLifting the burden: State Medicaid expansion reduces financial risk for the injured
2020, Journal of Trauma and Acute Care Surgery
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