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  • Effect of Insurance and Racial Disparities on Outcomes in Traumatic Brain Injury Patients

    Final Number:

    Michael Schiraldi MD, PhD; Chirag G. Patil MD MS; Debraj Mukherjee MD, MPH; Beatrice Ugiliweneza MSPH; Miriam Nuno PhD; Shivanand P. Lad MD PhD; Maxwell Boakye MD

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2012 Annual Meeting

    Introduction: We aimed to describe disparities between commercially insured, Medicaid, and Medicare patients. We further study racial disparities within a relatively homogenous Medicaid population.

    Methods: We reviewed MarketScan database (2000-2009) for adult TBI patients. Univariate and multivariate analysis were performed for mortality, length of stay (LOS), payments, and use of post-hospitalization rehabilitation or emergency department (ED) services.

    Results: Our study included 92,159 patients; commercial insurance, Medicaid, and Medicare were utilized by 44,108, 19,743 and 28,308 individuals, respectively. In-hospital death was lowest for commercially insured (5.0%) vs. 7.6% and 8.5% for Medicaid and Medicare patients, respectively (p<0.0001). Multivariate analysis showed that Medicaid patients were almost twice as likely to have a complication than the commercially insured (OR=1.8). Medicaid patients had longer hospitalizations than commercially insured (12 days vs. 6 days, p<0.0001). Mean inpatient charges were least for Medicare ($17,374) and greatest for Medicaid patients ($42,438); charges for commercially insured averaged $35,280 (p=<0.0001). Rehabilitation was utilized by 13.4% commercially insured vs. 9.1% Medicaid patients; 16.6% of Medicare patients utilized rehabilitation (p=<0.0001). Mean ED visits totaled 4 for both commercially insured and Medicare patients; Medicaid patients averaged 26 ED services (p=<0.0001). A subset of 17,627 Medicaid patients was used to examine racial disparities; 12,847 patients were Caucasian and 4,780 were African American (AA). In-hospital mortality (7.6% vs. 7.9%, p=0.50) and LOS (12 vs. 13 days, p=0.45) were similar between Caucasians and AAs, respectively. Mean hospital payments were higher ($51,837 vs. $39,615, p=<0.0001), rehabilitation services were used less frequently (8.2% vs. 9.7%, p=0.0018), and ED services were used more frequently (31 vs. 26 visits, p=<0.0001) by AAs relative to Caucasians.

    Conclusions: Insurance and racial disparities continue to exist for TBI patients. Insurance status appears to impact short and long-term outcomes to a greater degree than patient race.

    Patient Care: Practitioners should be aware of the effect of race and insurance on the outcomes of patients so that they can minimize the disparities in their practice.

    Learning Objectives: By the conclusion of this session participants should be able to describe the effect of insurance and racial disparities on the outcomes of patients with with traumatic brain injuries.


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