Faculty Collaboration Database

Mandatory health care insurance is associated with shorter hospital length of stay among critically injured trauma patients. J Trauma Acute Care Surg 2014 Aug;77(2):298-303

Date

07/25/2014

Pubmed ID

25058257

DOI

10.1097/TA.0000000000000334

Scopus ID

2-s2.0-84904973471 (requires institutional sign-in at Scopus site)   8 Citations

Abstract

BACKGROUND: The implementation of the Affordable Care Act stimulated interest in outcomes of patients in Massachusetts, a state mandating health insurance as of 2006. We sought to determine the impact of an insurance mandate on hospital use and outcomes among trauma intensive care unit (ICU) patients.

METHODS: This is a retrospective cohort study of trauma patients admitted to the ICU conducted at an academic, trauma center. Patients before (2004-2006) and after (2008-2012) the implementation of mandatory health insurance were compared using propensity matching to control for confounders. Outcomes were hospital length of stay (LOS), ICU LOS, in-hospital mortality, and discharge disposition.

RESULTS: Overall, 1,668 trauma patients were included, with 530 matched on the propensity score in each group. Hospital LOS decreased by a median of 2.0 days, from 9.0 days (interquartile range, 4-15 days; p < 0.01) before to 7.0 days (interquartile range, 4-14) after implementation of the legislation. There were no differences in ICU LOS (3.0 days to 3.0 days, p = 0.44) and mortality (odds ratio [OR], 1.16; 95% confidence interval [CI], 0.83-1.63). Compared with discharges to home, the patients were more likely to be discharged home with home health services after the legislation (OR, 1.70; 95% CI, 1.08-2.68), but there was no significant change in the likelihoods of the patients being discharged to skilled nursing and rehabilitation facilities (OR, 0.97; 95% CI, 0.72-1.31).

CONCLUSION: Implementation of health care reform was associated with a decrease in hospital LOS, with an increase in use of home health services and no change in ICU LOS and mortality among trauma ICU patients at our institution.

LEVEL OF EVIDENCE: Prognostic/epidemiologic study, level III.

Author List

Lee J, Sudarshan M, Kurth T, Kaafarani H, Klein E, Yeh DD, deMoya MA, Eikermann M, Shah K, Velmahos G, Raja AS

Author

Marc Anthony De Moya MD Chief, Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Female
Health Care Reform
Hospital Mortality
Hospitalization
Humans
Injury Severity Score
Insurance, Health
Length of Stay
Male
Mandatory Programs
Massachusetts
Middle Aged
Propensity Score
Retrospective Studies
Wounds and Injuries