(I-657) Payer Status is a Predictor for Long Hospital Stay Among Patients Presenting to the Emergency Department with a C2 Fracture in the United States
Medical Student University of South Florida Morsani College of Medicine Tampa, Florida, United States
Introduction: Demographic factors such as race, gender, and payer type have been shown to impact the delivery of care. However, it is unknown how these factors influence the management of CT fracture care. Thus, we aim to identify disparities regarding length of stay (LOS) among individuals presenting with a C2 fracture with regard to payer type.
Methods: Our study is a cross-sectional analysis of emergency department visits and supplemental inpatient data from October 2015 through 2019 from the Nationwide Emergency Department Sample (NEDS). A multivariable logistic regression model was used to estimate the odds of increased length of stay for each payer type using Medicare payer type as the standard. Increased length of stay was defined as 75th percentile length of stay for all people presenting with C2 fractures. A multivariable regression model was also used to estimate the odds of increased length of stay based on patient gender and race.
Results: The total number of emergency department visits recorded in the NEDS database for a C2 fracture from October 2015 through 2019 was 7,725. Further, 4,965 visits had Medicaid payer status, and, of these, 633 visits experienced increased length of stay. Comparatively, Medicaid and Private insurance payer status were significantly more likely to experience increased length of stay compared to Medicare payer type (OR 4.20, [95% CI: 1.30, 13.27]; P < 0.015) and (OR 1.90, [95% CI: 1.08, 3.32]; P < 0.024), respectively. Conversely, female gender was found to have a decreased chance of increased length of stay (OR 0.53 [95% CI: 0.37, 0.76]; P < 0.001) and race was found to not significantly impact odds of increased length of stay.
Conclusion : In this study, patients with Medicaid and private insurance payer status were more likely to have increased length of stay while female patients had a decreased likelihood of increased length of stay. Clinicians should be made aware of these disparities to allow equitable delivery of care regardless of demographic characteristics and payer type.
