title: Health care disparities in the acute management of venous thromboembolism based on insurance status in the U.S.
abstract: Acute venous thromboembolism (VTE) is common, costly, and potentially lethal. Therapeutic anticoagulation requires timely, closely monitored medical follow-up. If ineffective, clinical outcomes worsen and resource utilization increases. This risk may be magnified in uninsured patients. This study examined VTE care in hospital patients and investigated differences based on insurance status. We performed a retrospective chart review on medical VTE patients at an academic teaching hospital between December 1, 2007 and April 30, 2009. We reviewed medical records for demographics, insurance, admission status, length of stay (LOS), and 30-day Emergency Department (ED) recidivism and hospital readmission. Measured outcomes were analyzed based on payer source. We identified 234 medical VTE patients; 67 patients were uninsured (28.6%). 106 patients (45.3%) presented with deep vein thrombosis only. Most VTE patients were admitted to the hospital (171; 73.1%), including all 128 pulmonary embolism patients. Admitted uninsured patients averaged a LOS of 5.5 versus 3.7 days for insured (P = 0.03), with ED recidivism rates of 26.1 versus 11.3%, respectively (P = 0.02). Average cost for all VTE care in uninsured patients was $12,297 versus $7,758 for insured patients (P = 0.04). This study identified disparities in medical care and resource utilization for medical VTE patients based on insurance. Uninsured VTE patients were hospitalized nearly two additional days and were more than two times as likely to return to the ED within 30 days compared to insured patients. Additional research is needed to explain these disparities, and to explore system improvements for the uninsured VTE patient.
authors.affiliation: University of Colorado Denver, Denver, CO, USA. gregory.misky@ucdenver.edu
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Misky
authors.forename: Jonathan C
authors.initials: JC
authors.lastname: Manheim
authors.forename: Nichole
authors.initials: N
authors.lastname: Zehnder
authors.forename: Vicky
authors.initials: V
authors.lastname: Nguyen
authors.forename: Paul F
authors.initials: PF
authors.lastname: Swenson
authors.forename: Patrick
authors.initials: P
authors.lastname: Klem
authors.forename: Toby
authors.initials: T
authors.lastname: Trujillo
authors.forename: M A
authors.initials: MA
authors.lastname: Earnest
mesh_terms: D019468:Disease Management; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data*; D007902:Length of Stay; D017057:Medically Uninsured; D010359:Patient Readmission; D014481:United States; D054556:Venous Thromboembolism / Q000191:economics / Q000628:therapy*