Abstract 15621: Lack of Medical Insurance is an Independent Predictor of Increased Inter-Facility Transfer for St-Elevation Myocardial Infarction in U.S. Emergency Departments
Introduction: Only 31% of U.S. hospitals have primary percutaneous coronary intervention (PCI) capabilities for patients with ST-elevation myocardial infarction (STEMI). Lack of medical insurance has been shown to affect the decision to transfer from U.S. emergency departments (ED), but its effect on transfer to PCI centers for STEMI is unknown.
Hypothesis: Lack of medical insurance is related to higher ED transfer rates for patients with STEMI.
Methods: We used the Nationwide Emergency Department Sample (NEDS) to model predictors of transfer among ED patients diagnosed with STEMI between 2006 and 2011. Our multivariable logistic regression model included ED disposition as the outcome (transfer vs admit to same hospital), insurance status as the primary exposure (none, government, private, and other), controlling for age group, gender, year, US region, ED patient volume, household income in patient’s home zip code, and weekend presentation.
Results: Our sample included 1,428,653 ED STEMI visits, including 259,376 (18.2%) transfers. STEMI transfer rates increased from 15% in 2006 to 20.5% in 2011. The adjusted odds ratio for transfer among self-pay patients compared with those with government insurance was 1.80 (95% CI 1.64,1.98) and compared to those with private insurance was 1.27 (95% CI 1.17,1.39) (Table).
Conclusions: Controlling for other variables (Table), having no medical insurance was independently associated with higher transfer rates compared with having private or government insurance. These results suggest that insurance status influences the location of care for patients presenting to the ED with STEMI. Further research is required to explore illness severity and facility factors.
Author Disclosures: M.J. Ward: None. S. Kripalani: None. Y. Zhu: None. A.B. Storrow: None. T.J. Wang: Research Grant; Modest; Diasorin. Consultant/Advisory Board; Modest; Critical Diagnostics, Pfizer. Other; Modest; The MGH has applied for a patent related to the use of microRNA antagonists to increase ANP production to treat hypertension and heart failure, and the author may be entitled to royalties, The MGH has applied patents related to the use of metabolomic biomarkers for cardiometabolic disease.. T. Speroff: None. D. Munoz: None. J.L. Fredi: None. R.S. Dittus: None. F.E. Harrell: None. W.H. Self: None.
- © 2014 by American Heart Association, Inc.