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

平价医疗法案医疗补助扩大对年轻人创伤护理和结果差异的影响

• 批准号: 9922388
• 负责人: Jennifer N. Cooper
• 金额: $ 24.16万
• 依托单位: RESEARCH INST NATIONWIDE CHILDREN'S HOSP
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-04-26 至 2021-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9922388
• 关键词: Accident and Emergency department; Accounting; Admission activity; Adult; Affect; Affordable Care Act; American Hospital Association; Area; Caring; Cause of Death; Cessation of life; Characteristics; Communities; Community Hospitals; Complex; Data; Data Linkages; Databases; Elderly; Emergency Situation; Emergency department visit; Evaluation; Failure; Federal Government; Financial cost; Future; Geographic state; Geography; Goals; Health Insurance; Health Personnel; Health Services Accessibility; Health Status; Hispanics; Hospital Costs; Hospital Mortality; Hospitalization; Hospitals; Improve Access; Injury; Inpatients; Insurance; Insurance Coverage; Low income; Medicaid; Medical; Military Personnel; Minority; Not Hispanic or Latino; Operative Surgical Procedures; Outcome; Outpatients; Patients; Pattern; Policies; Policy Maker; Policy Making; Population; Preventive healthcare; Provider; Race; Registries; Rehabilitation therapy; Reporting; Research; Resources; Social Class; Structure; Surveys; Time; Trauma; Trauma patient; Traumatic injury; Uninsured; United States; Work; acute care; aged; care outcomes; cost; disability; disparity reduction; ethnic minority population; experience; follow-up; health care disparity; high risk; hospital readmission; improved; injured; longitudinal analysis; low socioeconomic status; mortality; racial and ethnic; racial and ethnic disparities; racial disparity; readmission rates; rehabilitative care; rural area; rural patients; safety net; severe injury; socioeconomic disparity; socioeconomics; trauma care; trauma centers; waiver; young adult

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.

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 影响美国人口的所有细分市场，但是在获得高质量创伤护理和 受伤后的结果。在年轻人，未保险的患者中，居住在低收入的患者 社区和黑人患者的院内死亡率较高。低收入和黑色 受伤后，西班牙裔患者也不太可能接受康复护理。这些社会经济和 被保险患者的种族/种族差异降低。在实施负担得起的护理之前 ACT（ACA），超过20％的住院创伤患者没有保险，这一比例很大 低收入和种族/族裔少数民族患者中的较高。通过ACA扩展医疗补助是 实施以增加低收入成年人的健康保险范围。它降低了百分比 没有保险的创伤患者。但是，它在全国范围内对已知的社会经济和 创伤和结果中存在的种族/种族差异尚不清楚。缺乏保险不是 仅将这些差距视为未保险的机制才与许多可能的因素相关 独立影响创伤结果，例如较差的伤害前健康状况，更大的治疗延迟， 提供者偏见和资源较低的医院的治疗。但是，保险直接影响的证据 创伤结果差异的覆盖范围来自具有普遍保险范围的人群 作为老年人和军事人员，没有看到这些差异。需要进一步的研究 了解ACA医疗补助扩张对创伤中种族/种族和社会经济差异的影响 护理和结果，并阐明了该政策可能降低这些差异的机制。 该项目将利用2010-2017州的住院和州急诊室数据库。 国家以及有关医院结构和财务特征的数据，以评估ACA医疗补助的影响 在创伤护理和年轻人中的社会经济和种族/种族差异的扩展 因受伤住院。我们旨在评估ACA医疗补助的扩张是否减轻了In- 严重后，医院死亡率，转移模式，计划外的再入院和获得康复护理的机会 非西班牙裔黑人患者，西班牙裔患者和来自低收入社区的患者受伤。我们也是 旨在确定哪些类型的医院在其结局中经历了最大的改善 少数民族和低社会经济地位年轻成人创伤患者。该项目将为决策者和 医疗保健提供者清楚地了解了健康保险扩展对低收入成年人的影响 创伤结果中的种族/种族和社会经济差异。与联邦政府和各州 该项目辩论医疗补助的各种更改，将及时提供有关潜在影响的信息 每年在美国，成千上万的年轻人受到严重伤害的政策。