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- Title
Association of Emergency Department Evaluation With Public Insurance Use and Treatment Delays for ACL Injury.
- Authors
Zhu, Angela S.; Morrissey, Patrick; Byrne, Rory A.; Albright, J. Alex; Lemme, Nicholas J.; Cruz Jr, Aristides I.; Owens, Brett D.
- Abstract
Background: Utilization of an emergency department (ED) visit for anterior cruciate ligament (ACL) injury is associated with high cost and diagnostic unreliability. Hypothesis: Patients initially evaluated at an ED for an ACL injury would be more likely to be from a lower income quartile, use public insurance, and experience a delay in treatment. Study Design: Cohort study; Level of evidence, 3. Methods: Patients in the Rhode Island All Payers Claims Database who underwent ACL reconstruction (ACLR) between 2012 and 2021 were identified using the Current Procedure Terminology (CPT) code 29888. Patients were stratified into 2 cohorts based on CPT codes for ED or in-office services within 1 year of ACLR. A chi-square analysis was used to test for differences between cohorts in patient and surgical characteristics. Multivariable linear and logistic regression were used to determine how ED evaluation affected timing and outcome variables. Results: While adjusting for patient and operative characteristics, patients in the ED cohort were more likely to have Medicaid (29% vs 12.5%; P <.001) and be in the lowest income quartile (44.6% vs 32.1%; P <.001). ED visit and Medicaid status were associated with increased time to (1) diagnostic magnetic resonance imaging, adding 7.97 days on average (95% CI, 4.14-11.79 days; P <.001) and 8.40 days (95% CI, 3.44-13.37 days; P =.001), respectively; and (2) surgery, adding 20.30 days (95% CI, 14.10-26.49 days; P <.001) and 12.88 days (95% CI, 5.15-20.60 days; P =.001), respectively. Patients >40 years who were evaluated in the ED were 2.5 times more likely to require subsequent ACLR (odds ratio, 2.50 [95% CI, 1.01-6.21]; P =.049). Conclusion: In this study, patients who visited the ED within 1 year before ACLR were more likely to have a lower income, public insurance, increased time to diagnostic imaging, and increased time to surgery, as well as decreased postoperative physical therapy use and increased subsequent ACLR rates in the 40-49 years age-group.
- Subjects
NEW England; STATISTICS; HOSPITAL emergency services; HOMOGRAFTS; CONFIDENCE intervals; PHYSICAL therapy; MULTIPLE regression analysis; POSTOPERATIVE care; TREATMENT delay (Medicine); MEDICAL care use; RISK assessment; SOCIOECONOMIC factors; ANTERIOR cruciate ligament injuries; HEALTH insurance; RESEARCH funding; CHI-squared test; ANTERIOR cruciate ligament surgery; MEDICAID; DATA analysis; DATA analysis software; ODDS ratio
- Publication
Orthopaedic Journal of Sports Medicine, 2023, Vol 11, Issue 11, p1
- ISSN
2325-9671
- Publication type
Article
- DOI
10.1177/23259671231212241