Insurance status
Bratton et al. describe an association between the outcomes of patients
admitted to the PICU and their insurance status33. The
primary goal of this retrospective cohort, including the data of
fourteen PICU’s, was to determine whether there was an association
between insurance status and PICU LOS, as well as the length of
mechanical ventilation in children admitted with asthma. They found that
children admitted with severe asthma with a public health insurance were
significantly more likely to not only receive mechanical ventilation,
but also had longer use of mechanical ventilation, and a longer LOS
compared to the children with the same illness severity yet insured by
commercial or Health Maintenance Organization (HMO)
insurance33. Also, Epstein et al. reported an
association between having government insurance, as opposed to indemnity
insurance, and a higher PIM2-score at admission in children with
respiratory diseases at the PICU16. Finally, Silber et
al. evaluated the effect of both insurance status and ethnicity on
outcome34. In this multivariate, matched cohort study
across thirty-three states that, among other things, compared the
outcome between white and black children who were admitted to the
hospital with asthma and had a Medicaid (public health) insurance, it
was found that race did not influence re-admissions or deaths. However,
they did find a small but significant difference in PICU use and the LOS
at the PICU in black children34.