Health Care Reform and Disparities in the Care and Outcomes of Trauma Patients

描述（由申请人提供）：医疗保健改革（HCR）是至关重要的国家议程。该项目将分析马萨诸塞州（MA）HCR对创伤护理提供和质量差异的影响，并确定护理提供基础设施和政策的变化，这些变化对于质量改进、成本降低和最终消除这些差异至关重要。创伤性损伤是MA和美国65岁之前潜在寿命损失的主要原因，每年在MA，创伤夺去近2，000人的生命，并与约53，000例住院治疗和超过25亿美元的急性护理医院费用有关。先前对HCR MA前医疗保健数据的分析记录了创伤护理的交付和结果的显著地理，社会经济和种族/民族差异。 本研究将重点关注5组具有临床和政策意义的结局和质量指标，包括1）利用率，2）死亡率，3）质量指标，4）出院处置，5）创伤护理成本。将使用多水平模型分析MA政府机构在2002年至2011年期间常规收集的数据，包括1）创伤监测系统，2）急诊科出院数据库，3）住院患者出院数据库，4）门诊观察数据库，5）生命记录和统计登记，以及6）所有付款人索赔数据库。这些数据库由MA立法机构授权。具体目标是：目标1：确定实施MA HCR之前和之后5组关键成果和质量指标中差异的预测因素、程度和时间变化;目标2：通过比较差异指数及其HCR之前和之后的组成部分，确定MA HCR对减少这些差异的影响，以及目标3：制定关于基础设施和创伤护理政策关键变化的循证建议，以改善结果并消除HCR已经到位时的差异。 2006年颁布了《医疗保健法》，以普及医疗保健并改善健康状况。然而，很少有人知道这是否实际上提高了经济边缘化人口的医疗保健利用率，减少了医疗质量的差异，从而改善了健康结果。据我们所知，这种调查尚未进行。因此，这项拟议的调查将填补一个关键的知识差距的作用，HCR在消除医疗保健的差距，提供及时的，独特的，和有价值的信息，目前的政策辩论国家HCR。 公共卫生相关性：该项目调查了马萨诸塞州医疗改革对创伤护理差异的影响。这些发现将填补医疗保健改革在消除医疗保健差距方面的重要知识空白，为当前关于国家医疗保健改革的政策辩论提供及时，独特和有价值的信息。

DESCRIPTION (provided by applicant): Health Care Reform (HCR) is of paramount importance to the national agenda. This project will analyze the impact of Massachusetts (MA) HCR on disparities in the delivery and quality of trauma care and identify changes in care delivery infrastructure and policies that are critical for quality improvement, cost reduction and ultimate elimination of those disparities. Traumatic injuries are the leading cause of potential years of life lost before age 65 in MA and in the U.S. Each year in MA, trauma claims nearly 2,000 lives, and is associated with around 53,000 inpatient hospitalizations, and more than $2.5 billion acute care hospital charges. Previous analysis of pre-HCR MA healthcare data documented significant geographic, socioeconomic and racial/ethnic disparities in the delivery and outcomes of trauma care. This proposed investigation will focus on 5 groups of outcomes and quality indicators that are of clinical and policy significance, including 1) utilization, 2) mortality, 3) quality indicators, 4) discharge dispositions, and 5) cost of trauma care. Multi-level models will be used to analyze data routinely collected by MA government agencies between 2002 and 2011, including 1) Trauma Surveillance Systems, 2) Emergency Department Discharge Database, 3) Inpatient Hospital Discharge Database, 4) Outpatient Observation Stay Database, 5) Registry of Vital Records and Statistics, and 6) All Payers Claims Database. These databases are mandated by MA legislature. The specific aims are: Aim 1: To determine the predictors, extent and temporal changes of disparities in the 5 groups of key outcomes and quality indicators, before and after the implementation of MA HCR; Aim 2: To determine the impact of MA HCR on the reduction of these disparities by comparing disparity indices and their components before and after the HCR, and Aim 3: To develop evidence-based recommendations on critical changes in infrastructure and trauma care policies to improve outcomes and eliminate disparities when HCR is already in place. The MA HCR law was enacted in 2006 to provide universal access to medical care and to improve health. However, little is known about whether this has actually improved health care utilization by economically marginalized populations, reduced disparities in the quality of care, and consequently improved health outcome. To our knowledge, such an investigation has not been carried out. This proposed investigation will thus fill a critical knowledge gap on the role of HCR in eliminating health care disparities by providing timely, unique, and valuable information to the current policy debate on national HCR. PUBLIC HEALTH RELEVANCE: This project investigates the impact of Massachusetts health care reform on disparities in trauma care. The findings will fill a critical knowledge gap in the role of healthcare reform in elimination of health care disparities, adding timely, unique, and valuable information to the current policy debate on national health care reform.