Patients transferred for emergency upper extremity evaluation: does insurance status matter?

Area of Science:

• Orthopedic Surgery
• Health Services Research
• Socioeconomic Determinants of Health

Background:

• Academic medical centers frequently manage patients referred for specialized hand surgery.
• Understanding the characteristics of these transferred patients is crucial for resource allocation and care optimization.

Purpose of the Study:

• To analyze the demographic and insurance profiles of patients transferred for hand surgery evaluation.
• To compare these characteristics against a cohort of non-transferred patients.

Main Methods:

• Retrospective review of 155 transferred and 1017 non-transferred patients with hand diagnoses over three months.
• Data collected included insurance status (present/absent, favorable/unfavorable), comorbidities, employment, and transfer reasons.
• Unfavorable insurance included Medicaid or state-sponsored plans.

Main Results:

• Transferred patients were more likely to be male (69.9% vs 59.7%) and unemployed (55.1% vs 64.8%).
• While overall insured rates were similar, transferred patients had a higher proportion of no or unfavorable insurance (30.1% vs 22.9%).
• Poor/no insurance doubled the likelihood of inappropriate transfer (OR 2.17). Common transfer reasons included fractures, infections, and amputations.

Conclusions:

• Patients referred to tertiary centers for emergency upper extremity issues disproportionately present as male, unemployed, and with unfavorable or no insurance.
• These findings suggest potential socioeconomic factors influencing access to timely and appropriate hand surgery care.