American Association for Hand Surgery

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Examining the Impact of Insurance Type on Self-Reported Symptom Severity at the Preoperative Visit for Carpal Tunnel Release
David N. Bernstein, MBA, MA1, Etka Kurucan, BA1, Kathleen Fear, PhD1, Bilal Mahmood, MD1, Constantinos Ketonis, MD, PhD1 and Warren C Hammert, M.D.2, (1)University of Rochester Medical Center, Rochester, NY, (2)Department of Orthopaedics, University of Rochester, Rochester, NY

Introduction. The literature shows that patients with certain insurance types have easier access to healthcare. However, there is limited literature quantifying if patient symptoms are worse at the time of intervention. If worse, this may suggest that patients with “lesser” insurance tend to have greater symptom burden prior to getting the appropriate treatment or delay seeking care for other reasons. The primary null hypothesis is insurance type is not associated with PROMIS Upper Extremity (UE), Physical Function (PF), Pain Interference (PI), and Depression scores at the preoperative visit before carpal tunnel release (CTR).


Materials & Methods. Patients with known carpal tunnel syndrome presenting for their preoperative visit within 3 months of carpal tunnel release to a tertiary academic hand clinic between 12/2016 and 11/2018 completed PROMIS UE, PF, PI and Depression CATs. A chart review for insurance type was completed, and insurance type was recorded as Commercial, Medicare, Medicaid, or Workers Compensation. Descriptive patient characteristics were determined and bivariate analyses were conducted to compare patient variables by insurance status. Using accepted stepwise regression methods, patient characteristics with p<0.10 were included in the multivariable linear regression to determine which variables are associated with PROMIS scores at the final preoperative visit before CTR.


Results. 301 patients were included in our analysis. In bivariate analysis, there was no difference in the number of days between preoperative visit and CTR (p=0.49) or race (p=0.11) by insurance type. A significantly greater percentage of women had Medicaid (75%; p=0.009) and the age of those with Medicare was significantly higher than other insurance types (68.70 years; p<0.01). All PROMIS domains were significantly different by insurance type, with Medicaid patients having the worst preoperative score for all domains and commercial patients having the best (p<0.01) (Table 1). In multivariable linear regression, age was associated with PROMIS UE (β = 0.17, p=0.03) and PROMIS PI (β = -0.19, p=0.01), while Commercial Insurance was associated with PROMIS PF (β = 4.78, p<0.01), PROMIS PI (β = -3.58, p=0.04), and PROMIS Depression (β = -4.27, p=0.04) (Table 2).


Conclusions. Commercial Insurance is associated with significantly improved preoperative PROMIS PF, PI, and Depression scores compared to Medicaid, suggesting that those who have private insurance may have better access to care or overall better health. In addition, increased age was associated with improved preoperative PROMIS UE and PI scores, suggesting that older patients may be able to better cope with carpal tunnel sequelae.



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