Insurance status impacts acute VTE care
MedWire News: Uninsured patients with venous thromboembolism (VTE) have longer hospital stays and are more likely to return to the emergency department (ED) postdischarge than insured patients with the same condition, US research shows.
Previous studies have demonstrated disparities in care processes and mortality between insured and uninsured patients for a variety of conditions, such as myocardial infarction and cancer, but none have looked at VTE.
To address this, Gregory Misky and colleagues from the University of Colorado in Denver examined the differences in care received by insured and uninsured patients hospitalized for VTE (deep vein thrombosis and pulmonary embolism [PE]) during a 17-month period.
A retrospective review of medical records identified 234 medical patients with acute VTE. Of these, 67 (28.6%) were uninsured.
The majority (73.1%) of patients, including all of those with PE (n=128), were admitted to the hospital.
The researchers observed a similar admission rate between uninsured and insured patients (68.7% vs 74.9%), but the uninsured patients spent an average 1.8 days longer in hospital than insured patients (mean length of stay 5.5 vs 3.7 days).
In addition, significantly more uninsured patients returned to the ED within 30 days of discharge compared with insured patients, at 26.1% versus 11.3%, respectively. However, readmission rates were similar between the two groups, at 10.9% versus 8.9%.
Misky and co-authors suggest that the differences they observed might be due, in part, to uninsured patients not having access to a reliable primary care provider.
"We postulate inpatient providers might be appropriately concerned about discharging patients from the hospital if they do not believe that timely and safe follow-up can be delivered," they write in the Journal of Thrombosis and Thrombolysis.
The team also assessed the costs associated with caring for uninsured versus insured patients with VTE.
They found that, despite representing only 28.6% of VTE patients, uninsured patients accounted for 36.8% of total costs.
Indeed, the combined cost of ED and hospital care (including revisits) per uninsured patient was US$4539 (€3331) more than the cost of care per insured patient.
The researchers conclude that their study provides "strong evidence that uninsured patients receive different anticoagulation care and highlights the need to identify barriers in standardization of care for this population."
"Additional research is needed to explain these disparities, and to explore system improvements for the uninsured VTE patient," they add.
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By Laura Dean