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

描述(由申请人提供)：卫生保健改革(HCR)对国家议程至关重要。该项目将分析马萨诸塞州(MA)HCR对创伤护理提供和质量方面的差异的影响，并确定护理提供基础设施和政策方面的变化，这些变化对于提高质量、降低成本和最终消除这些差异至关重要。在马萨诸塞州和美国，创伤是导致65岁之前潜在寿命损失的主要原因。在马萨诸塞州，创伤每年夺走近2000人的生命，与大约5.3万名住院患者和超过25亿美元的急性护理医院费用有关。以前对HCR-MA前医疗保健数据的分析记录了创伤护理的提供和结果方面存在显著的地理、社会经济和种族/民族差异。这项拟议的调查将集中于具有临床和政策意义的5组结果和质量指标，包括1)利用率、2)死亡率、3)质量指标、4)出院处置和5)创伤护理费用。多层次模型将用于分析MA政府机构在2002至2011年间收集的常规数据，包括1)创伤监测系统，2)急诊科出院数据库，3)住院出院数据库，4)门诊观察停留数据库，5)生命记录和统计登记表，6)所有付款人索赔数据库。这些数据库是由MA立法机构授权的。具体目标是：目标1：确定五组主要成果和质量指标实施前后差异的预测因素、程度和时间变化；目标2：通过比较差异指数及其组成部分，确定管理和健康状况报告对缩小这些差异的影响；目标3：就基础设施和创伤护理政策的关键变革提出循证建议，以改善成果并消除已有的差异。2006年颁布了MA HCR法，以提供普遍获得医疗保健和改善健康的机会。然而，很少有人知道这是否真的改善了经济边缘人群的保健利用情况，缩小了保健质量上的差距，从而改善了健康结果。据我们所知，还没有进行过这样的调查。因此，这项拟议的调查将通过为当前关于国家卫生改革的政策辩论提供及时、独特和有价值的信息，填补关于卫生政策改革在消除卫生保健差距方面的作用的关键知识空白。 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距的影响。这些发现将填补医疗改革在消除医疗差距方面的关键知识空白，为当前关于国家医疗改革的政策辩论增加及时、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.