Effects of Affordable Care Act Medicaid Expansion on Disparities in Trauma Care and Outcomes in Young Adults

项目摘要/摘要 创伤是美国年轻人死亡和残疾的主要原因。创伤 影响到美国人口的所有部分，但在获得高质量的创伤护理和 受伤后的结果。在年轻人中，没有保险的患者，居住在低收入家庭的患者 社区和黑人患者的风险调整后住院死亡率较高。低收入和黑人 西班牙裔患者在受伤后接受康复治疗的可能性也较小。这些社会经济和 减少了参保患者之间的种族/民族差异。在实施平价医疗之前 ACT(ACA)，超过20%的住院创伤患者没有保险，这一比例 在低收入和种族/少数民族患者中较高。通过ACA扩大医疗补助计划是 实施以增加低收入成年人的医疗保险覆盖面。它降低了这一比例 没有保险的创伤患者。然而，它在全国范围内对已知的社会经济和 在创伤护理和结果方面存在的种族/族裔差异仍然不清楚。缺乏保险并不是 这些差异背后的唯一机制是没有保险，这与许多因素相关，这些因素可能 独立影响创伤结局，如受伤前健康状况较差，治疗延误较大， 提供者的偏见，以及在资源较少的医院接受治疗。然而，保险直接影响的证据 关于创伤结局差异的保险来自于拥有全民保险的人群，如 作为老年人和军人，这些差异在他们身上看不到。还需要进一步的研究来 了解扩大ACA医疗补助对创伤中种族/民族和社会经济差异的影响 护理和结果，并阐明这项政策可能缩小这些差距的机制。 该项目将利用美国18个州2010-2017年的州住院病人和州急诊部数据库 以及关于医院结构和财务特征的数据，以评估ACA医疗补助的效果 扩大年轻人在创伤护理和结果方面的社会经济和种族/族裔差距 因伤入院治疗。我们的目标是评估ACA医疗补助计划的扩大是否缓解了以下方面的差距： 住院死亡率、转院模式、计划外再入院和严重急性呼吸综合征后康复护理的可及性 非西班牙裔黑人患者、西班牙裔患者和低收入社区患者的伤害。我们也 目的是确定哪些类型的医院在其 少数族裔和低社会经济地位的青壮年创伤患者。该项目将为决策者和 清楚了解医疗保险扩大到低收入成年人的影响的医疗保健提供者 创伤结局中的种族/族裔和社会经济差异。与联邦政府和各州 在讨论医疗补助的各种变化时，该项目将及时提供有关以下各项潜在影响的信息 这样的政策针对美国每年数十万严重受伤的年轻人。

Project Summary/Abstract Trauma is the leading cause of death and disability among young adults in the United States. Trauma affects all segments of the US population, but large disparities exist in access to high quality trauma care and outcomes after injury. Among young adults, uninsured patients, patients who reside in low income communities, and black patients have higher risk-adjusted rates of in-hospital mortality. Low income and black and Hispanic patients are also less likely to receive rehabilitative care after injury. These socioeconomic and racial/ethnic disparities are reduced among insured patients. Prior to the implementation of the Affordable Care Act (ACA), more than 20% of hospitalized trauma patients were uninsured, with this proportion being much higher among low income and racial/ethnic minority patients. Medicaid expansion through the ACA was implemented to increase health insurance coverage among low income adults. It has reduced the percentage of trauma patients who are uninsured. However, its effects nationally on the known socioeconomic and racial/ethnic disparities that exist in trauma care and outcomes remain unclear. Lack of insurance is not the only mechanism underlying these disparities as being uninsured is correlated with numerous factors that may independently affect trauma outcomes, such as poorer pre-injury health status, greater treatment delay, provider bias, and treatment at lower resourced hospitals. However, evidence for the direct impact of insurance coverage on disparities in trauma outcomes comes from populations with universal insurance coverage such as the elderly and military personnel, in whom these disparities are not seen. Further research is needed to understand the effect of ACA Medicaid expansion on racial/ethnic and socioeconomic disparities in trauma care and outcomes and elucidate the mechanisms by which this policy may have reduced these disparities. This project will utilize 2010-2017 State Inpatient and State Emergency Department Databases from 18 US states as well as data on hospital structural and financial characteristics to evaluate the effect of ACA Medicaid expansion on socioeconomic and racial/ethnic disparities in trauma care and outcomes among young adults hospitalized for injury. We aim to evaluate whether ACA Medicaid expansion has mitigated disparities in in- hospital mortality, transfer patterns, unplanned readmissions, and access to rehabilitative care after serious injury for Non-Hispanic black patients, Hispanic patients, and patients from low income communities. We also aim to determine what types of hospitals have experienced the largest improvements in outcomes among their minority and low socioeconomic status young adult trauma patients. This project will provide policy makers and healthcare providers with a clear picture of the impact of health insurance expansion to low income adults on racial/ethnic and socioeconomic disparities in trauma outcomes. With the federal government and states debating a variety of changes to Medicaid, this project will provide timely information on the potential effects of such policies on the hundreds of thousands of young adults seriously injured in the US each year.