Not All Care Is Equal: Differences in Care of Venous Thromboembolism among Insured and Uninsured Patients

Background:

Venous thromboembolism (VTE) is a common and potentially lethal problem. The 2009 Joint Commission has set new goals for the standard of care for all patients with VTE. To our knowledge, no research exists investigating disparities in VTE hospital care between insured and uninsured patients. This study evaluated VTE patients at University of Colorado Hospital (UCH] and describes differences in care by payer source.

Methods:

A retrospective chart review was performed on patients diagnosed with acute VTE at UCH between December 1, 2007, and April 1,2009. Medical records were reviewed for patient demographics, payer source, admission status, length of stay (LOS), cost for Die initial visit, return ED visits (ED recidivism) and read missions within 30 days for VTE‐related care. Measured outcomes were analyzed based on payer source.

Results:

A total of 234 VTE patients were identified, of whom 67 (28.6%) were uninsured. Uninsured patients were younger on average (45.6 vs. 56.2; P < 0.001) and more commonly had DVT (56.7% vs. 40.7%; P = 0.026). Admitted uninsured patients average LOS was 5.46 days and 3.68 days for insured patents (P = 0.007). The average initial visit for uninsured cost $8545 versus $6015 (P < 0.001). Rales of ED recidivism were 25.4% for uninsured patients compared with 13.8% for insured patients (P = 0.033), whereas readmission rates were similar at 9% and 7.9%, respectively (P = 0.767).

Conclusions:

This retrospective study identified a difference in care for VTE patients based on payer source. Uninsured patients disproportionately represent all patients with VTE at UCH, given that less than 20% of the local adult population is uninsured. Additionally, resource utilization varies between groups. Despite being younger and more commonly having DVT, uninsured VTE patients utilize nearly 2 additional days of inpattent care, cost $2530 more per initial visit, and are nearly twice as likely to return to the ED within a month for VTE‐related care, although overall readmission rates differ only slightly. This study warrants exploration of the cause for both the inpatient care discrepancy and fallow‐up differences between uninsured and insured patients with VTE at UCH. There is potential for improving care and conserving limited resources in managing VTE through development of a standardized care pathway.

Author Disclosure:

P. Swenson, University of Colorado, School of Medicine, student; V. Nguyen, University of Colorado, School of Medicine, student; N. Zefinder, University of Colorado, Department of Internal Medicine; M. Earnest, University of Colorado, Department of Internal Medicine; K. Mellis, University of Colorado, Department of Internal Medicine; G. Misky, University of Colorado, Department of Internal Medicine.