title: Patients transferred for emergency upper extremity evaluation: does insurance status matter?
abstract: BACKGROUND
  Academic institutions receive many patients transferred specifically for hand surgery evaluation. The purpose of this study was to evaluate the demographics and insurance status of patients transferred for this reason.
  
  
  METHODS
  A retrospective review was performed of 155 transferred and 1017 nontransferred patients with a primary hand diagnosis during 3 summer months at two urban academic institutions. Patients were evaluated for insurance status/type, medical comorbidities, employment status, and reason for transfer. Insurance was defined as present/absent and favorable/unfavorable, with unfavorable defined as Medicaid or state-sponsored insurance. Reason for transfer or presenting diagnosis was separated by category.
  
  
  RESULTS
  The mean age was similar between groups, but a higher percentage of transfer patients were men (69.9 percent versus 59.7 percent; p < 0.05). The percentage of insured patients was similar (92.9 percent versus 93.2 percent), but the number with no insurance or undesirable insurance was greater for transferred patients (30.1 percent versus 22.9 percent; p < 0.05). Patients with poor or no insurance were twice as likely to be inappropriately transferred (OR, 2.17; p = 0.03). Transferred patients were less likely to be employed (55.1 percent versus 64.8 percent; p < 0.05); however, the percentages of workers' compensation (13.5 percent versus 14.6 percent) and diabetes (6.41 percent versus 6.10 percent) cases were similar. Common reasons for transfer were closed fractures/dislocations (21.9 percent), infection (17.4 percent), and amputation/devascularization (17.4 percent).
  
  
  CONCLUSIONS
  Patients transferred to tertiary care centers for emergency upper extremity evaluation have a higher rate of undesirable or no insurance and are more likely to be male or unemployed.
authors: Boston, Mass.; and Norfolk, Neb. From the Division of Plastic Surgery, Massachusetts General Hospital, Harvard Medical School; Faith Regional Health Services; and the Department of Orthopedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School.
authors: Kyle R
authors: KR
authors: Eberlin
authors: Tristan L
authors: TL
authors: Hartzell
authors: Phoebe
authors: P
authors: Kuo
authors: Jonathan
authors: J
authors: Winograd
authors: Charles
authors: C
authors: Day
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D004630:Emergencies; D005260:Female; D006230:Hand Injuries / Q000175:diagnosis* / Q000601:surgery; D006801:Humans; D019458:Insurance Coverage; D008297:Male; D008875:Middle Aged; D010360:Patient Transfer; D012189:Retrospective Studies; D062606:Tertiary Care Centers; D034941:Upper Extremity / Q000293:injuries; D055815:Young Adult