Correlation of Health Insurance Provider to Orthopedic Patient Reported Outcome Measures

CATEGORY: Insurance, Outcomes INTRODUCTION/PURPOSE: Previous research has suggested that patient insurance type can influence health-related measures, including patient survival, quality of care, clinical outcomes after certain injuries, and likelihood of returning to work following orthopedic injury. Patient reported outcome measures (PROMs) are a way of evaluating patients’ self-perception of health and function. The aim of this study is to determine if insurance type is associated with trends in PROMs scores in a general population of orthopaedic foot and ankle patients. METHODS: We retrospectively reviewed the electronic medical records of 14,447 adult foot and ankle patients who had completed PROMs questionnaires from 2015 to 2017. We evaluated the following validated PROMs: Foot and Ankle Ability Measure (FAAM), PROMIS Global Short Form (both Physical and Mental Sub-scores), and PROMIS Physical Function Short Form 10A. Descriptive analyses, ANOVA, and Tukey HSD post-hoc analyses were conducted to evaluate trends of PROMs scores relative to insurance type. RESULTS: The mean age of patients was 54.6 years, with 64.8% of patients being female (Table 1). Patients with Workers Comp/Motor Vehicle insurance (n=61) had the lowest mean FAAM, PROMIS Global – Physical Score, and Physical Function Short Form 10A score. Medicaid patients (n=836) had the lowest mean PROMIS Global – Mental Scores. Patients with Commercial insurance (n=9088) consistently had the highest PROMs scores (Table 1). Statistical analyses showed the scores of patients with Commercial insurance to be statistically significantly higher than the pooled scores of all other patients (Table 2). Significantly poorer scores were also seen for Workers Comp/Motor Vehicle as compared to the rest of the cohort (Table 2). CONCLUSION: This analysis reveals differences in PROMs amongst patients with different health insurance providers. In general, patients with Workers Comp/Motor Vehicle and Medicaid had poorer outcomes scores than those with Medicare or Commercial insurance. These differences were statistically significant and exceed published MCIDs for FAAM and PROMIS PF 10A. While further research is required, as we did not control for different diagnoses, we believe this is useful information in characterizing how patient insurance type can impact patient reported outcomes.