Understanding the Effect of Hospital Safety-Net Burden on Inpatient Outcomes Following Status Epilepticus
Abstract number :
1.364
Submission category :
13. Health Services (Delivery of Care, Access to Care, Health Care Models)
Year :
2021
Submission ID :
1825519
Source :
www.aesnet.org
Presentation date :
12/4/2021 12:00:00 PM
Published date :
Nov 22, 2021, 06:43 AM
Authors :
Maryam Syed, MBBS - Wayne State University School of Medicine; Ayaz Khawaja, MD - Assistant Professor - Clinical, Neurology, Wayne State University School of Medicine; Deepti Zutshi, MD - Associate Professor - Clinical, Neurology, Wayne State University School of Medicine; Maysaa Basha, MD - Associate Professor - Clinical, Neurology, Wayne State University School of Medicine; Rohit Marawar, MD - Assistant Professor - Clinical, Neurology, Wayne State University School of Medicine
Rationale: Safety-net hospitals tend to serve as centralized hubs that offer care for vulnerable patient populations (i.e. those with Medicaid insurance and/or uninsured individuals). Despite their willingness to offer care to disadvantage communities, these facilities are often subject to complex payment reforms that indirectly influence the healthcare resources they have. Although prior studies have shown that hospitals having high safety-net burdens have worse outcomes following major surgeries, it is unknown if the same exists for other medical conditions. The purpose of the current study was to evaluate whether the increasing safety-net burden of hospitals was associated with worse outcomes following status epilepticus in adult populations.
Methods: The 2005 to 2014 National Inpatient Sample (NIS) was queried using International Classification of Diseases 9th Edition code (345.3) to identify adults (18 years and above) undergoing admission for status epilepticus. Using a prior validated definition, safety-net burden was defined as the proportion of uninsured or Medicaid patients that were treated by hospitals. Based on the quartiles of these proportions, the hospitals were defined into – 1) Low burden hospital/LBH (1st quartile), 2) Medium burden hospital/MBH (2nd and 3rd quartile), and 3) High burden hospital/HBH (4th quartile). Multivariate logistic regression analyses were used to assess whether the increasing safety-net burden was associated with adverse outcomes.
Results: A total of 137,410 adult patients admitted with status epilepticus were included in the study – out of which 14,629 (10.6%) were treated in a LBH, 85,971 (62.6%) were treated in a MBH, 18,281 (13.3%) were treated in a HBH, and the remainder had unknown data about a facility. Patients who underwent treatment in a MBH (vs. a LBH) had higher odds of experiencing pulmonary complications (OR 1.20 [95% CI 1.14-1.26]; p< 0.001), pneumonia (OR 1.13 [95% CI 1.03-1.23]; p< 0.001), renal complications (OR 1.12 [95% CI 1.03-1.22]; p=0.006), metabolic complications (OR 1.20 [95% CI 1.11-1.29]; p< 0.001) and hematologic complications (OR 1.52 [95% CI 1.25-1.85]; p< 0.001). Patients who underwent treatment in a HBH, as compared to a LBH, had higher odds of experiencing pneumonia (OR 1.32 [95% CI 1.19-1.47]; p< 0.001), metabolic complications (OR 1.26 [95% CI 1.15-1.39]; p< 0.001) and hematologic complications (OR 1.71 [95% CI 1.34-2.19]; p< 0.001).
Health Services (Delivery of Care, Access to Care, Health Care Models)