TOPLINE:
Among patients with ST-segment elevation myocardial infarction (STEMI) in California, uninsured patients had significantly lower odds of interfacility transfer compared with their insured counterparts regardless of the facility’s percutaneous coronary intervention (PCI) capabilities.
METHODOLOGY:
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It’s prohibited to transfer patients on the basis of ability to pay, but evidence suggests insurance status may affect transfer decision-making in emergency care, the authors write. However, uninsured STEMI patients may also simply be presenting to hospitals that don’t offer more advanced care.
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This cohort study examined whether insurance status was associated with the odds of transfer. The investigators took into account facilities’ PCI capabilities.
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The study included 32,841 adult patients with STEMI who presented to the emergency department (ED) and were transferred to another facility from 2010-2019. The mean age of the patients was 64 years, and 6.6% were uninsured.
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The primary outcome was transfer status from the presenting ED of a PCI-capable hospital, which was defined hospitals with case volumes of at least 36 PCIs per year.
TAKEAWAY:
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After adjustment, including for a facility’s PCI capability, the odds of transfer for uninsured patients to a PCI-capable hospital were lower than for insured patients (odds ratio, 0.93).
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“A key factor that may contribute to the reduced odds of transfer for uninsured patients with STEMI from facilities with PCI capabilities is California’s robust STEMI regionalization, which was completed in 2014,” the authors write.
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“Combined with disproportionate presentation of uninsured patients to facilities without PCI capabilities and to those with lower volume facilities, these findings suggest regionalization alone is not enough to enhance the quality and timeliness of care for socioeconomically disadvantaged populations,” they write.
IN PRACTICE:
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The authors conclude that their findings warrant further investigation to understand characteristics of facilities and outcomes for uninsured STEMI patients.
STUDY DETAILS:
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The study was conducted by Michael J. Ward, MD, PhD, Vanderbilt University Medical Center, Nashville, Tennessee, and colleagues. It was published online June 9 in JAMA Network Open.
LIMITATIONS:
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The study used administrative data, which have inherent limitations. It was not possible to examine clinical factors at presentation or to account for factors such as patient hemodynamic stability that may affect transfer. Findings may not be generalizable to states other than California.
DISCLOSURES:
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The study was supported by the National Heart, Lung, and Blood Institute, the National Center for Research Resources, and the National Center for Advancing Translational Sciences. Disclosures are available in the original article.
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