Research Center for Social Protection and Health Economics (PROESA), University Icesi, Cali, Colombia.
Eval Rev. 2012 Apr;36(2):133-64. doi: 10.1177/0193841X12442674.
Injury is the leading cause of death for persons aged 1-44 years in the United States. Injuries have a substantial economic cost. For that reason, regional systems of trauma care in which the more acutely injured patients are transported to Level-I (L-I) trauma centers (TCs) has been widely advocated. However, the cost of TC care is high, raising questions about the value of such an approach.
To study L-I TC effectiveness and study return-to-work (RTW) outcomes.
Using data from National Study on the Costs and Outcomes of Trauma, the authors address the issue of selection bias by comparing naive estimates to matching techniques, as well as to nonlinear instrumental variable models (2SRI) and bivariate probit estimators.
Individuals ages 18-64 who were mainly working before traumatic injury. Patients selected for the study were treated at 69 hospitals located in 12 states in the United States. N = 1790.
Treatment is binary indicator on whether treated at L-I TC. Outcome is binary indicator on whether returned to work within 3 months after injury. Covariates include: demographics, pre-injury characteristics (job, health and insurance status), injury descriptors, other income sources, etc.
Across all models that control for unobserved factors, the authors find that L-I TC treatment is positively associated with RTW within 3 months after injury. The estimated average marginal effect of treatment on the probability of RTW ranges from 23 to 38 percentage points.
Benefits of L-I TC care extend beyond mortality and morbidity.
在美国，1-44 岁人群的死亡原因首位是伤害。伤害具有巨大的经济成本。因此，广泛倡导建立创伤救治区域体系，将更严重的受伤患者转运至一级创伤中心（TC）。然而，TC 治疗的费用高昂，这引发了对这种方法的价值的质疑。
研究一级 TC 的效果和研究重返工作岗位（RTW）的结果。
利用国家创伤成本和结果研究的数据，作者通过将天真估计与匹配技术进行比较，以及与非线性工具变量模型（2SRI）和双变量概率单位估计器进行比较，解决了选择偏差问题。
18-64 岁主要在创伤前工作的个体。研究选择的患者在 12 个州的 69 家医院接受治疗。n=1790。
治疗是在一级 TC 治疗的二进制指标。结果是受伤后 3 个月内是否重返工作的二进制指标。协变量包括：人口统计学特征、受伤前的特征（工作、健康和保险状况）、损伤描述符、其他收入来源等。
在控制未观察到的因素的所有模型中，作者发现一级 TC 治疗与受伤后 3 个月内的 RTW 呈正相关。治疗对 RTW 概率的平均边际效应估计值在 23%至 38%之间。
一级 TC 治疗的益处不仅限于死亡率和发病率。
