title: Does insurance status affect continuity of care for ambulatory patients with operative fractures?
abstract: BACKGROUND
  We compared insurance status among three groups of ambulatory patients with an operatively treated fracture of the distal part of the radius or of the ankle, in order to determine if insurance status affected continuity of care. The patients were categorized as having received initial care at our institution, having received initial care elsewhere with an identifiable reason for transfer to a tertiary care center, or having received initial care elsewhere with no identifiable reason for transfer.
  
  
  METHODS
  We conducted a retrospective review of 697 patients with an operatively treated distal radial fracture or ankle fracture who had received their definitive treatment at a level-I trauma center. Demographic data, the mechanism of injury, the insurance type, and the location of the initial care were recorded.
  
  
  RESULTS
  The proportion of uninsured or underinsured patients in the group that had had their initial treatment at our trauma center was similar to that in the group that had had a specific reason to seek definitive care with us (64% and 63%, p < 0.832). However, the proportion of uninsured or underinsured patients was significantly larger in the group that had not received initial care from us and had no specific reason to receive definitive care from us (82% vs. 63%, p < 0.001). With other variables held constant, the odds of being underinsured or uninsured were 2.53 times greater for the patients initially treated elsewhere who had no specific reason to receive definitive treatment from us.
  
  
  CONCLUSIONS
  These results suggest that nonmedical reasons play a role in determining where ambulatory patients with fractures requiring operative treatment are able to receive definitive care. Patients without specific medical or nonmedical reasons to receive definitive care at our center were significantly more likely to be uninsured or underinsured.
authors.affiliation: Department of Orthopaedic Surgery, University of California at Davis, Sacramento, California 95817, USA. philipwolinsky@hotmail.com
authors.forename: Philip
authors.initials: P
authors.lastname: Wolinsky
authors.forename: Sunny
authors.initials: S
authors.lastname: Kim
authors.forename: Michael
authors.initials: M
authors.lastname: Quackenbush
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000191:economics / Q000706:statistics & numerical data; D016512:Ankle Injuries / Q000000981:diagnostic imaging / Q000601:surgery; D002140:California; D002648:Child; D015331:Cohort Studies; D003266:Continuity of Patient Care / Q000191:economics* / Q000639:trends; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000379:methods*; D050723:Fractures, Bone / Q000000981:diagnostic imaging / Q000191:economics / Q000601:surgery*; D054625:Healthcare Disparities / Q000191:economics; D006801:Humans; D015601:Injury Severity Score; D019458:Insurance Coverage / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D017057:Medically Uninsured / Q000706:statistics & numerical data*; D008875:Middle Aged; D015999:Multivariate Analysis; D020380:Needs Assessment; D016017:Odds Ratio; D011859:Radiography; D011885:Radius Fractures / Q000000981:diagnostic imaging / Q000601:surgery; D012189:Retrospective Studies; D018570:Risk Assessment; D014193:Trauma Centers; D016896:Treatment Outcome; D055815:Young Adult