Author Interviews, Cost of Health Care, Emergency Care, Pediatrics / 26.10.2016
Uninsured Kids More Likely To Be Transferred From Emergency Departments
MedicalResearch.com Interview with:
[caption id="attachment_29187" align="alignleft" width="150"]
Yunru Huang and Dr. James Marcin (left)[/caption]
Yunru Huang
Ph.D. Candidate in epidemiology
Department of Pediatrics
University of California
Davis, Sacramento, CA
MedicalResearch.com: What is the background for this study?
Response: Each year, more than 27 million children seek care in emergency departments (EDs) in the United States. Many EDs, however, are not fully equipped with the recommended pediatric supplies and may not have access to the pediatric specialists and resources needed to provide definitive care. As a result, many children receiving treatment in EDs of hospitals with limited pediatric resources are transferred to another hospital’s ED or inpatient unit for admission.
The Emergency Medical Treatment and Active Labor Act (EMTALA) requires hospitals to make decisions on patient transfer and admission independent of insurance status. That is, the decision to transfer a patient to another hospital for admission should only depend upon clinical factors or the need for specialty services. However, patterns observed in the medical literatures have suggested that a child’s insurance status could be associated with transfer and admission decisions. These studies have been limited to single institutions and/or have been limited to specific conditions._ENREF_14 Whether or not transfer decisions among pediatric patients are related to insurance status has yet to be studied on a national level and across a variety of diagnoses.
We used Healthcare Cost and Utilization Project 2012 Nationwide Emergency Department Sample data and sought to investigate the relationships between insurance status and odds of transfer relative to local admission among pediatric patients receiving care in the ED.
Yunru Huang and Dr. James Marcin (left)[/caption]
Yunru Huang
Ph.D. Candidate in epidemiology
Department of Pediatrics
University of California
Davis, Sacramento, CA
MedicalResearch.com: What is the background for this study?
Response: Each year, more than 27 million children seek care in emergency departments (EDs) in the United States. Many EDs, however, are not fully equipped with the recommended pediatric supplies and may not have access to the pediatric specialists and resources needed to provide definitive care. As a result, many children receiving treatment in EDs of hospitals with limited pediatric resources are transferred to another hospital’s ED or inpatient unit for admission.
The Emergency Medical Treatment and Active Labor Act (EMTALA) requires hospitals to make decisions on patient transfer and admission independent of insurance status. That is, the decision to transfer a patient to another hospital for admission should only depend upon clinical factors or the need for specialty services. However, patterns observed in the medical literatures have suggested that a child’s insurance status could be associated with transfer and admission decisions. These studies have been limited to single institutions and/or have been limited to specific conditions._ENREF_14 Whether or not transfer decisions among pediatric patients are related to insurance status has yet to be studied on a national level and across a variety of diagnoses.
We used Healthcare Cost and Utilization Project 2012 Nationwide Emergency Department Sample data and sought to investigate the relationships between insurance status and odds of transfer relative to local admission among pediatric patients receiving care in the ED.
Dr. Celeste Torio[/caption]
Celeste M. Torio, Ph.D., M.P.H
Scientific Review Officer
AHRQ
MedicalResearch.com: What is the background for this study? What are the main findings?
Dr. Torio: Hospital care expenditures constitute the largest single component of health care spending. These expenses are of significant concern to policymakers because of their impact on governments, consumers and insurers.
MedicalResearch.com: What are the main findings?
• Aggregate hospital costs for 35.6 million hospital stays totaled $381.4 billion in 2013.
• Septicemia, osteoarthritis, newborn infants, complication of device, and acute myocardial infarction are the five most expensive conditions, and account for 1/5 of the total aggregate costs for hospitalizations.
• Sixty-three percent of aggregate hospital costs were covered by Medicare and Medicaid, while 28 percent were covered by private insurance and 5 percent were covered by the uninsured.
Dr. Nathalie Moise[/caption]
Nathalie Moise, MD, MS
Assistant Professor
Center for Behavioral Cardiovascular Health
Department of Medicine
Columbia University Medical Center
New York, NY 10032
MedicalResearch.com: What is the background for this study?
Dr. Moise: Our research aimed to compare the number of lives saved and changes in medical costs expected if intensive blood pressure goals of less than 120 mmHg were implemented in high cardiovascular disease risk patients.
In 2014, the 8th Joint National Committee (JNC8) on Detection, Evaluation, and Treatment of High Blood Pressure issued new guidelines recommending that physicians aim for a systolic blood pressure (SBP) of 140 mmHg in adults with diabetes and/or chronic kidney disease and 150 mmHg in healthy adults over age 60. The new guidelines represented a major departure from previous JNC7 guidelines recommending SBPs of 130 mmHg and 140, mmHg for these groups, respectively. Under the 2014 guidelines, over 5 million fewer individuals annually would receive drug treatment to lower their blood pressure, compared with the prior 2003 guidelines.
Recently, the Systolic Blood Pressure Intervention Trial (SPRINT) found that having a more intensive systolic blood pressure (SBP) goal of 120 mmHg in patients at high risk for cardiovascular disease reduced both cardiovascular events and mortality by about one quarter, compared with the current goal of 140 mmHg.
These recent studies and guidelines have created uncertainty about the safest, most effective and high-value blood pressure goals for U.S. adults with hypertension, but no prior study has compared the cost-effectiveness of adding more intensive blood pressure goals in high cardiovascular disease risk groups to standard national primary prevention hypertension guidelines like JNC8 and JNC7.
Our team at Columbia University Medical Center conducted a computer simulation study to determine the value of adding the lower, life-saving systolic blood pressure goal identified in SPRINT to the JNC7 and JNC8 guidelines for high-risk patients between the ages of 35 and 74 years. (High risk was defined as existing cardiovascular disease, chronic kidney disease, or a 10-year cardiovascular disease risk greater than 15 percent in patients older than 50 years and with a pre-treatment SBP greater than 130 mmHg)
Dr. Darius Lakdawalla[/caption]
Darius Lakdawalla PhD
Quintiles Chair in Pharmaceutical Development and Regulatory Innovation
School of Pharmacy
Professor in the Sol Price School of Public Policy
University of Southern California
MedicalResearch.com: What is the background for this study?
Dr. Lakdawalla: New treatments for hepatitis-C are highly effective but also involve high upfront costs. Because they effectively cure the disease, all the costs of treatments are paid over a short period of time – about three months – but the benefits accrue for the rest of a patient’s life. This creates problems for the private health insurance system, where patients switch insurers. The insurer that pays the bill for the treatment might not be around to enjoy the benefits of averting liver damage, liver transplants, and other costly complications associated with hepatitis-C.