Impact of the affordable care act's medicaid expansion on burn outcomes and disposition.
Impact of the affordable care act's medicaid expansion on burn outcomes and disposition.
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《平价医疗法案》的医疗补助扩张对烧伤结果和处置的影响。
DOI：
10.1016/j.burns.2020.10.030
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发表时间：
2021-03
期刊：
影响因子：
--
通讯作者：
Gibran NS
中科院分区：
文献类型：
--
作者：
Oh J;Fernando A;Sibbett S;Carrougher GJ;Stewart BT;Mandell SP;Pham TN;Gibran NS
我们的目的是分析《平价医疗法案》的医疗补助扩大对烧伤后临床结果和患者处置的影响。我们假设增加保险覆盖将导致改善的结果和更高的住院康复出院率。我们回顾了华盛顿大学地区烧伤中心2011年至2018年入院患者的注册数据。患者分为两类：医疗补助扩张之前（2011-2013年）和之后（2015-2018年）；我们排除了2014年的数据作为洗脱期。评估的结果包括住院时间、患者倾向和死亡率。采用多变量logistic和线性回归模型，协变量包括性别、年龄、烧伤大小、种族、距离烧伤中心的距离、烧伤病因和吸入性损伤的存在，以确定医疗补助扩大对结果的影响。未参保患者的比例下降，而医疗补助覆盖率增加。尽管扩大医疗补助后烧伤面积中位数增加，但住院病人死亡率没有变化，但平均急性护理时间增加了。更多患者出院进入康复中心。我们的研究证实了自医疗补助扩大以来保险覆盖面增加的先前发现。保险覆盖率的增加与烧伤后住院康复计划的出院率升高有关。
We aimed to analyze the impact of the Affordable Care Act’s Medicaid Expansion on clinical outcomes and patient disposition after burn injury. We hypothesized that increased insurance coverage would result in improved outcomes and higher rates of discharge to inpatient rehabilitation. We reviewed the University of Washington Regional Burn Center registry data for patients admitted from 2011 to 2018. Patients were grouped into two categories: before (2011-2013) and after (2015-2018) Medicaid expansion; we excluded 2014 data to serve as a washout period. Outcomes assessed included length of hospital stay, patient disposition, and mortality. Multivariable logistic and linear regression models with covariates for sex, age, burn size, race, distance from burn center, etiology of burn, and presence of inhalation injury were used to determine the impact of Medicaid expansion on outcomes. Rates of uninsured patients decreased while Medicaid coverage increased. Despite increased median burn size after Medicaid expansion, inpatient mortality rates did not change, but average acute care length of stay increased. More patients were discharged to rehabilitation centers. Our study corroborates prior findings of increased insurance coverage since Medicaid expansion. Increased insurance coverage is associated with higher rates of discharge to inpatient rehabilitation programs after burn injury.
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