Insurance status and hospital discharge disposition after XXXX : inequities in access to postacute care.

@entity1 @entity130
BACKGROUND: Postacute care is an essential component of medical care aimed at returning @entity130 @entity1 to their preinjury functional status. Rehabilitation services, skilled nursing facilities, and home care all play a role in facilitating the healing process. Access to such care may be limited based on insurance status, leaving the uninsured with limited resources to reach full recovery. We hypothesized that access to specialized postacute care is less available to @entity1 who lack health insurance. METHODS: A retrospective cohort of @entity130 @entity1 in the National @entity130 Databank from 2002 to 2006 was assessed to determine whether insurance status was a predictor of discharge to a specialized postacute care facility (rehabilitation, skilled nursing facilities, and home health). Using multivariate logistic regression, we assessed the likelihood of discharge to such facilities on the basis of insurance status, controlling for @entity1 demographics and injury severity. RESULTS: Adjusting for variation in age, race/ethicity, gender, and @entity130 and severity, uninsured @entity1 had the lowest odds of being discharged to a skilled nursing facility (odds ratio [OR], 0.76; 95% confidence interval [CI] 0.73-0.80; p<0.001), home health (OR, 0.51; 95% CI 0.49-0.53; p<0.001), and rehabilitation (OR, 0.45; 95% CI 0.44-0.46; p<0.001). Uninsured @entity1 had the highest odds, however, of being discharged directly home (OR, 1.32; 95% CI 1.30-1.34; p<0.001). CONCLUSION: Insurance status is an important predictor of hospital disposition and access to specialized posthospital care. Uninsured @entity1 are less likely to have access to the full range of medical care available to ensure complete recovery from traumatic injuries.
