title: Insurance status and hospital discharge disposition after trauma: inequities in access to postacute care.
abstract: BACKGROUND
  Postacute care is an essential component of medical care aimed at returning trauma patients 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 patients who lack health insurance.
  
  
  METHODS
  A retrospective cohort of trauma patients in the National Trauma 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 patient demographics and injury severity.
  
  
  RESULTS
  Adjusting for variation in age, race/ethicity, gender, and injury type and severity, uninsured patients 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 patients had the highest odds, however, of being discharged directly home (OR, 1.32; 95% CI 1.30-1.34; p<0.001).
  
  
  CONCLUSIONS
  Insurance status is an important predictor of hospital disposition and access to specialized posthospital care. Uninsured patients are less likely to have access to the full range of medical care available to ensure complete recovery from traumatic injuries.
authors.affiliation: Department of Health Policy and Management, Center for Surgery and Public Health, Harvard School of Public Health, and Division of Burn, Trauma, and Surgical Critical Care, Department of Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.
authors.forename: Greg D
authors.initials: GD
authors.lastname: Sacks
authors.forename: Caterina
authors.initials: C
authors.lastname: Hill
authors.forename: Selwyn O
authors.initials: SO
authors.lastname: Rogers
mesh_terms: D000293:Adolescent; D000328:Adult; D016001:Confidence Intervals; D016208:Databases, Factual; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D054625:Healthcare Disparities / Q000706:statistics & numerical data; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D015601:Injury Severity Score; D019458:Insurance Coverage / Q000706:statistics & numerical data; D007348:Insurance, Health / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010351:Patient Discharge / Q000706:statistics & numerical data; D044469:Racial Groups / Q000706:statistics & numerical data; D012044:Regression Analysis; D012189:Retrospective Studies; D014193:Trauma Centers / Q000706:statistics & numerical data; D014481:United States; D014947:Wounds and Injuries / Q000534:rehabilitation*; D055815:Young Adult