The Association Between Insurance Status and Prolonged ED Length of Stay for Deliberate Self-Harm and Suicide Attempt Admissions Public
Shim, Amy (Spring 2021)
Published
Abstract
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 1
Introduction 1
Background 2
Statement of Need 3
Proposed Solution 4
Methods 5
Objectives 6
Research Contribution 6
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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