Burn Patient Insurance Status Influences Hospital Discharge Disposition and Utilization of Post-Discharge Outpatient Care

Abstract

Abstract Post-discharge services, such as outpatient wound care, may affect long term health outcomes and post-recovery quality of life. Access to these services may vary according to insurance status and ability to withstand out-of-pocket expenses. Our objective was to compare discharge location between burn patients who were uninsured, publicly insured, or privately insured at the time of their burn unit admissions. A retrospective review from July 1, 2015 to November 1, 2019 was performed at an ABA-verified burn center. All inpatient burn admission patients were identified and categorized according to insurance payer type. The primary outcome was discharge location, and secondary outcomes included readmission and outpatient burn care attendance. In total, 284 uninsured, 565 publicly insured and 293 privately insured patients were identified. There were no significant differences in TBSA (P=0.3), inhalation injury (P=0.3), ICU days (P=0.09), or need for grafting (P=0.1). For primary outcome, uninsured patients were more likely to be discharged without ancillary services(P<0.0001). Publicly insured patients were more likely to receive skilled nursing care (P=0.0007). Privately insured patients were more likely to receive homecare (P=0.0005) or transfer for ongoing inpatient care (P<0.0001). There was no difference in burn unit readmission (P=0.5); uninsured were more likely to follow up with outpatient burn clinic after discharge (P=0.004). Uninsured patients were less likely to receive post-discharge resources. Uninsured patients receive fewer post-discharge wound care resources which could result in suboptimal long-term results, and diminished return to pre-injury functional status. Increased access to post-discharge resources will provide comprehensive care to more patients.