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Does Insurance Status Affect Continuity of Care for Ambulatory Patients with Operative Fractures?
Philip Wolinsky, MD1; Sunny Kim, PhD1; Michael Quackenbush, DO2
1 Department of Orthopaedic Surgery, University of California at Davis, 4860 Y Street, Suite 3800, Sacramento, CA 95817. E-mail address for P. Wolinsky: philipwolinsky@hotmail.com. E-mail address for S. Kim: sunnykim@ucdmc.ucdavis.edu
2 The Ohio State University, 4110 Cramblett Hall, 456 West 10th Avenue, Columbus, OH 43210. E-mail address: Michael.quackenbush@osumc.edu
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Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity.

Investigation performed at the Department of Orthopaedic Surgery, University of California at Davis, Sacramento, California

Copyright © 2011 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2011 Apr 06;93(7):680-685. doi: 10.2106/JBJS.J.00020
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Abstract

Background: 

We compared insurance status among three groups of ambulatory patients with an operatively treated fracture of the distal part of the radius or of the ankle, in order to determine if insurance status affected continuity of care. The patients were categorized as having received initial care at our institution, having received initial care elsewhere with an identifiable reason for transfer to a tertiary care center, or having received initial care elsewhere with no identifiable reason for transfer.

Methods: 

We conducted a retrospective review of 697 patients with an operatively treated distal radial fracture or ankle fracture who had received their definitive treatment at a level-I trauma center. Demographic data, the mechanism of injury, the insurance type, and the location of the initial care were recorded.

Results: 

The proportion of uninsured or underinsured patients in the group that had had their initial treatment at our trauma center was similar to that in the group that had had a specific reason to seek definitive care with us (64% and 63%, p < 0.832). However, the proportion of uninsured or underinsured patients was significantly larger in the group that had not received initial care from us and had no specific reason to receive definitive care from us (82% vs. 63%, p < 0.001). With other variables held constant, the odds of being underinsured or uninsured were 2.53 times greater for the patients initially treated elsewhere who had no specific reason to receive definitive treatment from us.

Conclusions: 

These results suggest that nonmedical reasons play a role in determining where ambulatory patients with fractures requiring operative treatment are able to receive definitive care. Patients without specific medical or nonmedical reasons to receive definitive care at our center were significantly more likely to be uninsured or underinsured.

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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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