The Association Between Insurance Status and Prolonged ED Length of Stay for Deliberate Self-Harm and Suicide Attempt Admissions Open Access

Shim, Amy (Spring 2021)

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Suicide is a serious public health problem and continues to take a devastating toll as one of the top ten leading causes of death in the United States. Additionally, non-suicidal self-injury (NSSI) has shown to be a robust risk factor to a future suicide attempt. An emergency department (ED) visit for NSSI or suicide attempts serves as a critical opportunity to survive and provide the necessary pathway to recovery. Despite the high short-term risk of a repeat suicide attempt, there is little known on the quality of ED care in addressing NSSI or suicide attempt admissions as well as how nonclinical factors like insurance status might impact care. This study examined whether ED care provision patterns, measured by prolonged LOS (length of stay) greater than or equal to 24 hours, were influenced by payer ability among this patient population. This four-state analysis (Arizona, Florida, New Jersey, New York) was conducted using the 2014 Healthcare Cost and Utilization Project (HCUP) State Emergency Department Databases (SEDD) and the 2014 American Hospital Association (AHA) Annual Survey. After controlling for individual and hospital covariates, Medicare and privately insured patients had a significantly lower likelihood of prolonged LOS (20% and 16%, respectively; p < .01) compared to uninsured patients. For patients with a home discharge, Medicare patients had a 23% lower likelihood than uninsured patients. There are evident disparities in ED care by insurance status, even when factors affecting LOS are controlled. Further policies should work to standardize the ED care management of NSSI and suicide attempts, paying particular focus to improving the timeliness of care provisions regardless of payer ability. 

Table of Contents

Chapter 1: Introduction



Statement of Need

Proposed Solution



Research Contribution

Chapter 2: Background and Literature Review 7

Background 7 

Deliberate Self-Harm and Suicide 8 

Emergency Department Admission 10 

Standard of Care for Patients with a Suicide Attempt 11 

Length of Stay 13 

Insurance Status and Length of Stay 14 

Current Literature 16 

Chapter 3: Methods 17 

Conceptual Framework 18 

Hypotheses 19 

Outcome of Interest 20 

Dataset Description 20 

Analytic Sample 21 

Statistical Analysis 23 

Measurements 24 

Chapter 4: Results 26 

Chapter 5: Discussion 32 

Summary 32 

Limitations and Strengths 34 

Study Implications 35 

Recommendations for Future Research 36 

References 37 

Appendix 43  

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