Findings from Harvard School of Dental Medicine Reveals New Findings on Managed Care (Is Insurance Payor Associated With Hospital Admission of Emergency Department Adult Patients With Odontogenic Infections?): Managed Care

Health Policy and Law Daily

2025 JAN 07 (NewsRx) -- By a News Reporter-Staff News Editor at Health Policy and Law Daily -- Researchers detail new data in Managed Care. According to news reporting originating in Boston, Massachusetts, by NewsRx journalists, research stated, “Patients who present to the emergency department (ED) with severe odontogenic infections are often hospitalized for surgical drainage and medical management. However, inpatient management of these patients can be financially burdensome.”

The news reporters obtained a quote from the research from the Harvard School of Dental Medicine, “While medical indications for hospital admission are well established, it remains unclear if patient insurance status is associated with admission. The purpose of this study was to determine the nationally representative estimates of the incidence of hospital admission for patients with odontogenic infections and the association with insurance payor. Setting, Sample: This retrospective cohort study used the 2018 Nationwide Emergency Department Sample. Patients with odontogenic infections (based on International Classification of Diseases, 10th Revision codes) were included. Patients aged <18 years or who had missing data were excluded. Predictor Variable: The primary predictor variable was primary payor (private insurance, Medicare, Medicaid, self-pay, and other). Variable: The primary outcome variable was hospital admission (yes/no). Covariates: Covariates included sociodemographic, medical, infection, and hospital variables. Analyses: Descriptive, bivariate, and multivariable logistic regression analyses were used to determine national estimates and predictors of admission. Odds ratios and 99% confidence intervals were computed. Discharge weights were accounted for in all analyses to provide nationally representative estimates. This study included 31,221 weighted ED encounters, of which 10,451 (33.5%) were admitted. In the study cohort, 7,687 (24.6%) had private insurance, 5,046 (16.2%) had Medicare, 10,070 (32.3%) had Medicaid, 7,436 (23.8%) were self-pay, and 982 (3.1%) had other. Bivariate analysis suggested that payor status was significantly associated with hospital admission (P < .01). The multivariable analysis showed that self-pay patients had significantly lower odds of hospital admission compared to those with private insurance (odds ratio, 0.54; 99% confidence interval, 0.42-0.70). Other independent predictors of hospital admission included infection in more than 1 location based on International Classification of Diseases, 10th Revision code, higher Charlson comorbidity index, and alcohol/substance use disorders. Conclusion and Relevance: Approximately one-third of patients presenting to the ED with odontogenic infections were admitted. Patients with no insurance were less likely to be admitted compared to those with private insurance.”

According to the news reporters, the research concluded: “This finding may reflect multiple possibilities, including hospital financial incentives.”

This research has been peer-reviewed.

For more information on this research see: Is Insurance Payor Associated With Hospital Admission of Emergency Department Adult Patients With Odontogenic Infections? Journal of Oral and Maxillofacial Surgery, 2024;82(12):1576-1584. Journal of Oral and Maxillofacial Surgery can be contacted at: W B Saunders Co-elsevier Inc, 1600 John F Kennedy Boulevard, Ste 1800, Philadelphia, PA 19103-2899, USA. (Elsevier - www.elsevier.com; Journal of Oral and Maxillofacial Surgery - http://www.journals.elsevier.com/journal-of-oral-and-maxillofacial-surgery/)

Our news correspondents report that additional information may be obtained by contacting Zachary S. Peacock, Harvard School of Dental Medicine, Boston, MA, United States. Additional authors for this research include Lang Liang, Tim T. Wang and Cameron C. Lee.

The direct object identifier (DOI) for that additional information is: https://doi.org/10.1016/j.joms.2024.08.062. This DOI is a link to an online electronic document that is either free or for purchase, and can be your direct source for a journal article and its citation.