Primary payer status in patients with seizures: A nationwide study during 1997-2014 in the United States.

OBJECTIVE: In countries where health coverage is not universal, there is ample evidence of disparities in healthcare, often associated with insurance. People with seizures, similar to those living with any complicated chronic medical comorbidity, need further health-related attention to improve their quality-of-life outcomes. METHODS: We conducted a retrospective cohort study of the National Inpatient Sample (NIS) component of the Healthcare Cost and Utilization Project (HCUP) national database between 1997-2014. The analysis focused on the mortality rate, and patients with a principal admission diagnosis of seizure at the time of discharge were identified. Primary Payer Status (PPS) included Medicare, Medicaid, private, and uninsured. Multivariate linear regression modeling was conducted to examine the contribution of the predictive variables to in-hospital mortality. RESULTS: Between 1997-2014, 4,594,213 seizure-related discharges was recorded. The overall mean patient age was 41.69 ± 0.98 years, and 58.1 % were female. The average age during this period decreased significantly in Medicare, increased substantially in uninsured, without significant change in Medicaid and private. Patients in Medicare had the highest length of stay (LOS) (4.49 ± 0.29 days), and uninsured (2.79 ± 0.15) had the least. Over time, there was a significant increase in the number of seizure discharges in Medicare, Medicaid, and private insurance. However, there was a significant decrease in in-hospital mortality in Medicare, Medicaid, and private, with the most prominent decline in Medicare. Risk-adjusted for age, gender, LOS, illness severity, and time, regression results showed Medicare has a significantly higher association with less in-hospital mortality compared with other insurances. CONCLUSIONS: Our study showed a significant increase in the number of seizure diagnoses at discharge in Medicare, Medicaid, and private in the United States between 1997-2014; however, there was a decrease in the in-hospital mortality rate across all insurance payers. Uninsured patients had the highest mortality rate after Medicare without risk justification. Risk-stratified models confirmed Medicare was significantly associated with a less in-hospital mortality rate.

The Life of a Black Medical Trainee in the United States: Past, Present, Future.

AN INTRODUCTION TO THE HISTORY OF BLACK MEDICAL TRAINEES: In these unprecedented times, Black medical professionals must deliver excellent medical care and uphold the highest standards of their profession while living through a devastating pandemic. They must do so in a time when the country tries to reconcile with generations of racism and injustice. The current social environment in America is particularly challenging for medical trainees such as medical students and resident physicians who must focus on their educational requirements and careers in settings that are often averse to addressing topics such as racism. This plight is not new for Black medical trainees, as they have been fighting for centuries to obtain an equitable seat at the table of medical education. Throughout the 19th century and early 20th century, Black physicians were repeatedly disenfranchised from the predominantly white medical societies, most notably the American Medical Association (AMA), which was established in 1847. Racially integrated medical organizations such as the National Medical Society of Washington D.C. (NMS), which was founded in 1870, were developed to challenge discriminatory practices of the American Medical Association against Black practitioners. The inception of the National Medical Association (NMA) in 1895 allowed Black doctors to advocate for disadvantaged patient populations and focus efforts on health issues pertinent to the underserved. THE STRUGGLES OF THE BLACK TRAINEE: However, Black and underrepresented minorities continue to face challenges with medical school matriculation and retention. A 2015 AAMC report showed that Black male medical school matriculants failed to increase significantly between 1978 and 2014. From 2006 to 2018, the number of Black medical school matriculants increased from 6.7% to 7.1%. SOLUTIONS FOR IMPROVING MEDICAL EDUCATION FOR THE BLACK TRAINEE: To improve these matriculation statistics, it is critical that institutions integrate innovative measures such as robust recruitment pipelines to expose underrepresented high school and college students to the medical field, as well as seek diversity actively in administration to dismantle the ingrained ideologies of systemic racism rooted in healthcare and medical education. To combat the institutionalized racism that has plagued medical education throughout its existence, collaboration as a unified front is essential to achieving the equity and social justice in healthcare that patients deserve.

Transient Ischemic Attack: The Trend and Readmissions in the United States.

INTRODUCTION: Transient ischemic attack (TIA) is a temporary event of neurological dysfunction. Patients with TIA may be discharged from the Emergency Department or following an observational admission since their symptoms have resolved. Some portion of these patients, however, return to the hospital due to various reasons. The aim of our study is to find the trend of TIA readmissions in the United States. MATERIALS AND METHODS: Using the Healthcare Cost and Utilization Project (HCUP) database, we analyzed TIA discharges and TIA readmissions between 2009-2014 using the statistical z-test. RESULTS AND STATISTICAL ANALYSIS: We recorded a total of 985,851 hospitalizations of patients discharged with TIA with a significant decrease from 2009 to 2014 (p<0.001). Patients had a mean age of 70.4 years and were mainly women (58.43%, P<0.01). HCUP reported 34,503 discharges due to TIA readmissions within 7 days (3.73%) and 91,261 discharges due to readmissions within 30 days (9.83%); both values showed a significant decrease during the study period. Summation of the TIA readmissions found that acute cerebrovascular disease was the leading cause of readmission, followed by another TIA in both seven and thirty days. CONCLUSION: Between 2009-2014 the rate of TIA and TIA readmissions has significantly decreased in the United States, especially in the female gender. Acute cerebrovascular disease and another TIA have been the leading cause of hospital readmissions. With a better understanding of the risk factors associated with hospital readmissions, it is possible to reduce the impending burden of these patients on the healthcare system.