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Abstract #153472

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Gordon S. Smith, MD, MPH, David A. Lombardi, PhD, and Julie Flahive, MS. Quantitative Analysis Unit, Liberty Mutual Research Institute for Safety, 71 Frankland Road, Hopkinton, MA 01748, 508 497 0250, gordon.smith@post.harvard.edu

Objectives: To assess the influence health insurance on place of injury treatment and evaluate representativeness of emergency department(ED) data for injuries.

Methods: We analyzed 7,834 medically treated injuries from the 2000-2003 National Health Interview Survey (NHIS). Place of treatment was defined hierarchically as the highest level of ambulatory care provided. We used weighted multiple logistic regression to compare place of treatment for injury episodes covered by private, public and no health insurance.

Results: We estimated 24.5 million injury episodes received medical treatment annually; 55% were treaded in EDs, 11% in clinics/outpatient departments, 28% in doctor's offices, and 3% sought only telephone advice. Privately insured patients used the ED for 50% of injury episodes compared to 64% among those publicly insured and 65% among persons uninsured. After controlling for age, race/ethnicity, geographic region, nature and cause of injury, there was no difference in place of treatment between publicly insured and uninsured persons. However compared to uninsured persons, patients with private insurance were significantly less likely to be treated in the ED for similar injuries (adjusted odds ratio, 0.56; 95% CI 0.47-0.66).

Discussion: Privately insured persons are significantly less likely to use the ED for injury treatment compared to those with public or no insurance, which may affect issues such as quality of and access to care, and costs. Surveillance based on ED databases may not be representative of all medically treated injures which may vary by health insurance status.

Learning Objectives:

• Describe where injured persons seek care for their injuries
• Examine the influence of health insurance on where injured persons seek care
• Evaluate the limitations of emergency department (ED) data for injury surveillance

Keywords: Data/Surveillance, Injury

Presenting author's disclosure statement:

Any relevant financial relationships? No
Any institutionally-contracted trials related to this submission?

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

• Audio (mp3) recording
• Slides (pdf) or Handout
• Multimedia recording