Association Between Insurance Type and Extended Length of Stay in Urban and Rural Vermont Hospitals
Conference Year
2023
Abstract
Cardiovascular disease is the second leading cause of death for Vermonters. By researching insurance type compared to patient outcomes such as length of stay, discharge status and diagnosis in Vermont, we intended to better understand the role health insurance plays in patient care between rural and urban patients aged 18 to 64. We conducted a cross-sectional study utilizing 2016 to 2020 data from the Vermont Uniform Hospital at Data Discharge System (VUHDDS) for patients admitted for heart and circulatory illnesses. Frequency statistics were run to determine distribution of sample characteristics and a two-side Z-test was conducted to compare differences between normal and extended lengths of stay. Two multivariable logistic regression models were utilized to control for confounding factors and identify differences in lengths of stay and mortality. Private insurance was more common among patients with a normal length of stay (46%) and public insurance more common among patients with extended lengths of stay (54%). Rural Medicare patients have 0.766 (CI: 0.656-0.895) times lower odds of extended length of stay, distinct from the 95% confidence interval for urban patients (CI: 0.944- 1.460). Urban Medicaid insured patients had 1.413 (CI: 1.151-1.735) times greater odds of an extended length of stay, which is outside of the 95% confidence interval for rural patients (CI: 0.798-1.086). Rural residency influences patient health outcomes for cardiac related discharges for patients in Vermont related to the patient's insurer. Future studies which include more demographic data are needed to better understand the implications of these findings.
Primary Faculty Mentor Name
Sarah Nowak
Graduate Student Mentors
Alyssa Oviedo, Mia Klonsky, Leah Grout
Status
Graduate
Student College
Larner College of Medicine
Program/Major
Public Health
Primary Research Category
Clinical
Association Between Insurance Type and Extended Length of Stay in Urban and Rural Vermont Hospitals
Cardiovascular disease is the second leading cause of death for Vermonters. By researching insurance type compared to patient outcomes such as length of stay, discharge status and diagnosis in Vermont, we intended to better understand the role health insurance plays in patient care between rural and urban patients aged 18 to 64. We conducted a cross-sectional study utilizing 2016 to 2020 data from the Vermont Uniform Hospital at Data Discharge System (VUHDDS) for patients admitted for heart and circulatory illnesses. Frequency statistics were run to determine distribution of sample characteristics and a two-side Z-test was conducted to compare differences between normal and extended lengths of stay. Two multivariable logistic regression models were utilized to control for confounding factors and identify differences in lengths of stay and mortality. Private insurance was more common among patients with a normal length of stay (46%) and public insurance more common among patients with extended lengths of stay (54%). Rural Medicare patients have 0.766 (CI: 0.656-0.895) times lower odds of extended length of stay, distinct from the 95% confidence interval for urban patients (CI: 0.944- 1.460). Urban Medicaid insured patients had 1.413 (CI: 1.151-1.735) times greater odds of an extended length of stay, which is outside of the 95% confidence interval for rural patients (CI: 0.798-1.086). Rural residency influences patient health outcomes for cardiac related discharges for patients in Vermont related to the patient's insurer. Future studies which include more demographic data are needed to better understand the implications of these findings.