K. Gee1, R. E. Jones1, A. Beres1 1University Of Texas At Southwestern,Department Of Surgery, Division Of Pediatric Surgery,Dallas, Tx, USA
Introduction: Tertiary referral centers exist to provide specialty and critical care for patients presenting to surrounding hospitals which lack these resources. However, there is a notion among tertiary centers that transferring hospitals are more likely to refer patients with unfavorable insurance coverage, and there is evidence to support this belief in adults and pediatric literature. Children’s Health in Dallas, Texas, is a large freestanding children’s hospital which frequently receives transfer requests for surgical patients. We examined funding status in patients transferred to our hospital for surgical management of acute appendicitis, hypothesizing that transferred patients were more likely to have Medicaid or no funding.
Methods: With IRB approval, the electronic medical record was queried retrospectively for all patients who underwent a laparoscopic appendectomy for acute appendicitis at our hospital between January 2011 and December 2015. Data retrieved included transfer status, funding source, and demographic variables such as age, sex, race, and ethnicity. Funding source was grouped in to three categories: commercial, Medicaid/ Children’s Health Insurance Plan (CHIP), or none. Transferred patients were compared to patients who presented directly. Descriptive analysis included determination of frequencies, means and standard deviations, and comparative statistics included with Chi squared test and t test.
Results: A total of 5,758 patients underwent laparoscopic appendectomy during the study period, of which 1,683 (29.2%) were transferred from other hospitals. Transfer patient were more likely to be older with a median age of 10.5 years versus 9.8 years in non-transferred patients (p=<0.0001). Additionally, transfer patients were more likely to identify as non-Hispanic than patients directly admitted (63.5% vs 50.0%, p=<0.0001). Transfer patients and directly admitted patients had similar rates of being uninsured, at 6.5% in direct patients and 6.1% in transferred patients (p = 0.5761). There was no difference in rate of Medicaid/CHIP coverage at 59.5% in directly admitted patients and 58.7% in transferred patients.
Conclusion: The rate of uninsured children in our study was 6.4%, which is slightly higher than the 5% national level. Our results show that patients transferred for laparoscopic appendectomy were just as likely to be uninsured as directly admitted patients, which contradicts evidence from other studies in which uninsured patients were more likely to be transferred. The underlying cause for this finding deserves further investigation, but could be attributed to regional phenomena or the diagnosis of acute appendicitis. This study highlights ongoing concerns that nonclinical factors affect interfacility transfer practices for pediatric patients.