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Published on: February 23, 2024
Does Payer Type Influence Pediatric Burn Outcomes? A National Study Using the Healthcare Cost and Utilization Project
Stephen Duquette1, Tahereh Soleimani, Brett Hartman
1From the Division of Plastic Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis.
Insights
Children with Medicaid insurance experienced more complications and longer hospital stays from burns compared to those with private insurance or self-pay. Payer type significantly impacts pediatric burn outcomes.
Area of Science:
- Pediatric medicine
- Health services research
- Burn injury outcomes
Background:
- Pediatric burns represent a significant public health concern in the U.S.
- Socioeconomic factors are known to affect disease outcomes.
- Understanding disparities in burn care is crucial for improving patient management.
Purpose of the Study:
- To investigate the association between payer type and outcomes in pediatric burn patients.
- To analyze national data on pediatric burn injuries based on insurance status.
- To identify potential socioeconomic disparities in burn care.
Main Methods:
- Retrospective analysis of the Kids' Inpatient Database (KID) from 2000-2009.
- Inclusion of patients aged 18 and under with burn-related diagnoses (Major Diagnostic code 22).
- Statistical analysis including descriptive, bivariate, and multiple regression models to assess payer type's impact on complications and length of stay (LOS).
Main Results:
- Medicaid was the primary payer for the majority of pediatric burn patients (52.3%).
- Medicaid patients were younger, from lower-income zip codes, and had a higher proportion of African-American individuals.
- Medicaid patients exhibited a higher overall complication rate and longer mean length of stay (LOS) compared to privately insured or self-pay patients.
Conclusions:
- Payer type, specifically Medicaid coverage, is significantly associated with increased complications and longer LOS in pediatric burn patients.
- These findings highlight socioeconomic disparities in pediatric burn care.
- Further research and targeted interventions are needed to address these outcome differences and improve care for vulnerable pediatric burn populations.
Abstract:
Pediatric burns are a considerable source of injury in the United States. Socioeconomic status has been demonstrated to influence other disease outcomes. The goal of this study was to analyze national pediatric burn outcomes based on payer type. A retrospective study was designed using the Kids' Inpatient Database (KID), years 2000 to 2009. Patients 18 years of age and under with Major Diagnostic code number 22 for burn were included. A total of 22,965 patients were identified, estimating 37,856 discharges. Descriptive and bivariate statistics were performed. Multiple regression analysis was used to assess correlation of payer type with complications and length of stay (LOS). The majority of patients were Medicaid (52.3%). Medicaid patients were younger (4.25, P < .05), had a higher rate of being in the first quartile of their zipcode's income (46.26%, P < .05), and contained a higher proportion of African-Americans (30.01%, P < .05). Overall complication rate was higher among Medicaid patients than private insurance and self-pay patients (6.64 vs 5.51 and 4.35%, respectively, P = .11). Logistic regression analysis of complications showed that Medicaid coverage (P < .001) was associated with complications. The geometric mean LOS among Medicaid patients was 3.7 days compared with private insurance (3.5 days) and self-pay patients (3.1 days). Medicaid patients had longer LOS and more complications. Regression analysis revealed that payer type was a factor in LOS and overall complication rate. Identifying dissimilar outcomes based on patient and injury characteristics is critical in providing information on how to improve those outcomes.
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