Disparities in length of stay for hip fracture treatment between patients treated in safety-net and non-safety-net hospitals

Coffield, Edward; Thirunavukkarasu, Saeyoan; Ho, Emily; Munnangi, Swapna; Angus, L.D. George

doi:10.1186/s12913-020-4896-1

Table 3 Negative binomial regression model: Association between length of stay, insurance type, and other factors^a

From: Disparities in length of stay for hip fracture treatment between patients treated in safety-net and non-safety-net hospitals

	Safety-net hospitals^b					Non-safety-net hospitals^b
	Coefficient	Std. Error	p-value	95% CI	% change	Coefficient	Std. Error	p-value	95% CI	% change
Demographics
Age (Referent: Age 70 years and over)
0–17	− 0.59	0.15	0.000	[− 0.89, − 0.29]	−44.8	−0.48	0.13	0.000	[−0.73, − 0.23]	− 38.3
18–29	− 0.13	0.08	0.121	[− 0.29, 0.03]	− 12.2	0.00	0.12	0.972	[− 0.24, 0.23]	− 0.4
30–49	− 0.04	0.04	0.298	[−0.12, 0.04]	−4.1	− 0.09	0.06	0.130	[−0.21, 0.03]	−8.6
50–69	0.05	0.02	0.029	[0.01, 0.1]	5.2	0.03	0.02	0.110	[−0.01, 0.06]	2.7
Gender (Referent: Male)
Female	−0.06	0.01	0.000	[−0.08, − 0.04]	−5.7	−0.06	0.01	0.000	[−0.08, − 0.04]	−5.7
Race (Referent: White)
Black/African American	0.20	0.07	0.003	[0.07, 0.33]	22.4	0.16	0.04	0.000	[0.09, 0.23]	17.3
Other	0.08	0.04	0.043	[0, 0.16]	8.4	0.00	0.03	0.942	[−0.05, 0.05]	−0.2
Ethnicity (Referent: Non-Spanish/Hispanic)
Spanish/Hispanic	0.06	0.04	0.121	[−0.02, 0.13]	6.1	−0.01	0.05	0.762	[−0.11, 0.08]	−1.5
Multiple ethnicities	−0.02	0.13	0.867	[−0.28, 0.24]	−2.2	0.05	0.11	0.661	[−0.17, 0.27]	5.0
Unknown	−0.03	0.06	0.664	[−0.15, 0.1]	−2.7	0.06	0.05	0.230	[−0.04, 0.16]	6.3
Clinical Indicators
Type of admission (Referent: Other^c)
Emergency, Trauma, Urgent	−0.54	0.11	0.000	[−0.75, − 0.33]	−41.7	−0.44	0.10	0.000	[−0.62, − 0.25]	−35.3
APR-DRG severity of Illness (Referent: Minor)
Moderate	0.12	0.02	0.000	[0.09, 0.15]	12.4	0.09	0.01	0.000	[0.07, 0.11]	9.5
Major	0.26	0.02	0.000	[0.22, 0.31]	30.1	0.25	0.01	0.000	[0.22, 0.28]	28.0
Extreme	0.79	0.04	0.000	[0.71, 0.87]	120.3	0.71	0.04	0.000	[0.64, 0.78]	103.6
APR-DRG risk of mortality (Referent: Minor)
Moderate	0.11	0.02	0.000	[0.08, 0.14]	11.4	0.13	0.01	0.000	[0.11, 0.16]	14.2
Major	0.28	0.02	0.000	[0.24, 0.31]	31.8	0.33	0.02	0.000	[0.29, 0.36]	38.4
Extreme	0.46	0.04	0.000	[0.38, 0.54]	58.3	0.50	0.03	0.000	[0.44, 0.57]	65.6
Hospital Indicators
Health insurance type (Referent: Commerical^d)
Medicaid	0.24	0.04	0.000	[0.16, 0.33]	27.3	0.20	0.03	0.000	[0.14, 0.27]	22.3
Medicare	0.04	0.03	0.136	[−0.01, 0.1]	4.4	0.00	0.02	0.952	[−0.04, 0.04]	−0.1
Dual Eligible (Medicaid/Medicare)	0.06	0.05	0.228	[−0.04, 0.15]	6.0	0.01	0.02	0.687	[−0.04, 0.06]	1.0
Self-pay	−0.04	0.06	0.543	[−0.15, 0.08]	−3.5	−0.02	0.05	0.733	[−0.11, 0.08]	−1.6
Other/unknown^e	0.19	0.04	0.000	[0.1, 0.28]	21.0	0.12	0.05	0.024	[0.02, 0.22]	12.3
Disposition (Referent: Home^f)
Expired	−0.29	0.06	0.000	[−0.42, − 0.17]	−25.3	−0.35	0.04	0.000	[−0.43, − 0.26]	−29.2
Inpatient rehabilitation facility	−0.03	0.07	0.653	[−0.17, 0.1]	−3.0	−0.05	0.03	0.150	[−0.11, 0.02]	−4.6
Nursing home/long term care^g	0.19	0.10	0.059	[−0.01, 0.39]	21.1	−0.03	0.05	0.499	[−0.13, 0.06]	−3.3
Skilled nursing facility	−0.03	0.05	0.469	[−0.12, 0.06]	−3.3	0.01	0.02	0.720	[−0.04, 0.05]	0.8
Other^h	−0.22	0.08	0.004	[−0.36, − 0.07]	−19.4	−0.28	0.04	0.000	[−0.36, − 0.2]	−24.6
N	16,310					32,638

Note. a. hospital type includes safety-net hospitals and non-safety-net hospitals where safety-net hospitals were defined as hospitals with a payer mix consisting of at least 30% of Medicaid and uninsured payers. b. illustrated statistics are coefficients and percent change amounts calculated through negative binomial regression models; the sample consisted of hip fracture patients from the SPARCS database with full covariate information; standard errors and 95% confidence intervals for the coefficients are also reported. c. other types of admission include: elective, newborn, and not available. d. commercial insurance includes: Blue Cross/Blue Shield; managed care, unspecific; and private health insurance. e. other insurance represents: Department of Corrections; federal/state/local/VA; other/miscellaneous; and unknown. f. patient discharged to: home or self-care; home with home health service; hospice (home); or left against medical advice. g. Medicaid Certified Nursing Home; Medicare Certified Long Term Care facility. h. patient discharged to: another facility not listed; cancer center or children’s hospital; court/law enforcement; critical access hospital; facility with custodial/supportive care; federal health care facility; hospital-based Medicare approved swing bed; hospice-medical facility; psychiatric hospital; short-term hospital

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