Journal Article

Disparities in length of stay for hip fracture treatment between patients treated in safety-net and non-safety-net hospitals

Munnangi, Swapna, Thirunavukkarasu, Saeyoan, Coffield, Edward, Ho, Emily, Angus, L.D. George

2020

Overview

Background Length of hospital stay (LOS) for hip fracture treatments is associated with mortality. In addition to patient demographic and clinical factors, hospital and payer type may also influence LOS, and thus mortality, among hip fracture patients; accordingly, outcome disparities between groups may arise from where patients are treated and from their health insurance type. The purpose of this study was to examine if where hip fracture patients are treated and how they pay for their care is associated with outcome disparities between patient groups. Specifically, we examined whether LOS differed between patients treated at safety-net and non-safety-net hospitals and whether LOS was associated with patients’ insurance type within each hospital category. Methods A sample of 48,948 hip fracture patients was extracted from New York State’s Statewide Planning and Research Cooperative System (SPARCS), 2014–2016. Using means comparison and X 2 tests, differences between safety-net and non-safety-net hospitals on LOS and patient characteristics were examined. Relationships between LOS and hospital category (safety-net or non-safety-net) and LOS and insurance type were further evaluated through negative binomial regression models. Results LOS was statistically ( p  ≤ 0.001) longer in safety-net hospitals (7.37 days) relative to non-safety-net hospitals (6.34 days). Treatment in a safety-net hospital was associated with a LOS that was 11.7% ( p = 0.003) longer than in a non-safety-net hospital. Having Medicaid was associated with a longer LOS relative to having commercial health insurance. Conclusion Where hip fracture patients are treated is associated with LOS and may influence outcome disparities between groups. Future research should examine whether outcome differences between safety-net and non-safety-net hospitals are associated with resource availability and hospital payer mix.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Adolescent / Adult / Age groups / Aged / Ambulatory care / Child / Child, Preschool / Clinical outcomes / Comparative analysis / economics and financing systems / expenditure / Female / Fracture repair / Fractures / Fractures (Injuries) / Funding / Health Administration / Health care disparities / Health care policy / Health disparities / Health Informatics / Health insurance / Health insurance industry / Health services / Healthcare Disparities / Hip fracture / Hip Fractures - therapy / Hip joint / Hospital stays / Hospitals / Humans / Indigent care / Infant / Infant, Newborn / Insurance / Insurance, Health - statistics & numerical data / Length of stay / Length of Stay - statistics & numerical data / Male / Medicaid / Medicaid - statistics & numerical data / Medical care discrimination / Medical care quality / Medical research / Medicine / Medicine & Public Health / Middle Aged / Mortality / New York / Nursing Research / Patient outcomes / Patient Protection & Affordable Care Act 2010-US / Patient safety / Public Health / Quality / Quality of care / Research Article / Safety-net hospital / Safety-net Providers - statistics & numerical data / Uninsured people / United States / Utilization / Young Adult