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The effect of discharge destination and primary insurance provider on hospital discharge delays among patients with traumatic brain injury: a multicenter study of 1,543 patients

Authors
  • Sorensen, Melissa1
  • Sercy, Erica1, 2, 3, 4
  • Salottolo, Kristin1, 2, 3, 4
  • Waxman, Michael3
  • West, Thomas A.2
  • Tanner, Allen II4
  • Bar-Or, David1, 2, 3, 4, 5
  • 1 Swedish Medical Center, Englewood, CO, USA , Englewood (United States)
  • 2 Medical City Plano, Plano, TX, USA , Plano (United States)
  • 3 Research Medical Center, Kansas City, MO, USA , Kansas City (United States)
  • 4 Penrose Hospital, Colorado Springs, CO, USA , Colorado Springs (United States)
  • 5 Injury Outcomes Network Research Group, 501 E Hampden Ave, Englewood, CO, 80113, USA , Englewood (United States)
Type
Published Article
Journal
Patient Safety in Surgery
Publisher
Springer (Biomed Central Ltd.)
Publication Date
Jan 06, 2020
Volume
14
Issue
1
Identifiers
DOI: 10.1186/s13037-019-0227-z
Source
Springer Nature
Keywords
License
Green

Abstract

BackgroundHospital length of stay (HLOS) is a commonly used measure of hospital quality and is influenced by clinical and non-clinical factors. To reduce HLOS, it is key to identify factors placing patients at increased risk of lengthy HLOS and discharge delays.MethodsThis was a retrospective cohort study of patients age ≥ 18 admitted to four level 1 trauma centers between 1/1/2015 and 3/31/2018 with traumatic brain injury (TBI). The primary outcome was discharge delay, defined as discharge ≥24 h after case management notes indicated the patient was ready for discharge. The independent variables of interest were primary insurance provider and discharge destination. Chi-square, Fisher exact, and unadjusted and adjusted logistic regression analyses were used to assess associations between discharge delay and the two primary independent variables, as well as other patient demographic and clinical characteristics. Complications developing during the delay period were also examined.ResultsA total of 1543 patients with TBI were included. The median age was 61 years, and the median HLOS was 5 days. Approximately half of patients were discharged home (54%). The most common insurance providers were Medicare (35%) and commercial/private (35%). Two-hundred ten (14%) patients experienced a discharge delay. The median delay period was 3 days, and the most common reasons for delay were insurance authorization (52%) and lack of accepting bed (41%). Compared to being discharged home, patients discharged to a skilled nursing facility (adjusted odds ratio (AOR) = 10.35) or intermediate care facility (AOR = 10.64) had the highest odds of discharge delay. Compared to Medicare patients, uninsured/self-pay patients (AOR = 2.98) and those with Medicaid (AOR = 2.83) or commercial/private insurance (AOR = 2.22) had higher odds of delay. Thirty-two patients (15% of those delayed) experienced at least one complication during the delay, some of which were clinically severe.ConclusionsA substantial portion of TBI patients in this study experienced discharge delays, and discharge destination and primary insurance provider were significant drivers of these delays. Evaluation of a facility’s quality of care should consider the specific causes of these delays.

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