Undurraga Perl Vicente Jose, Dodgion Chris, Hart Kyle, Ham Bruce, Schreiber Martin, Martin David Thomas, Zonies David
Oregon Health & Science University, Department of Surgery, Portland, OR, USA.
Oregon Health & Science University, Division of Trauma, Critical Care & Acute Surgery, Portland, OR, USA.
Am J Surg. 2017 May;213(5):870-873. doi: 10.1016/j.amjsurg.2017.03.036. Epub 2017 Apr 8.
We hypothesized that the ACA would shorten length of stay and increase numbers of insured patients without changing trauma patient outcomes.
A retrospective review of adult trauma patients admitted to a level I trauma center between 2012 and 2014 was performed. Demographics, length of stay, payer status, discharge disposition, and complications before and after the ACA implementation were analyzed.
4448 trauma patients were admitted during the study period. Patients treated after ACA implementation were older (53 vs 51, p = 0.05) with shorter ICU stays (1.7 vs 1.5 days, p = 0.04), but longer overall hospital stays (3.7 vs 4.1 days, p < 0.01). The proportion of self-pay patients decreased 11%-3% (p=<0.001). A higher proportion of patients were discharged to skilled nursing facilities (SNF, 17.1% vs 19.9%, p = 0.02). There was no change in rates of death, readmission, infection, pneumonia or decubiti.
Among trauma patients, there was a decrease in self-pay status and increase in public insurance without change in private insurance after implementation of the ACA. More patients were discharged to SNF without changes in reported outcomes.
我们假设《平价医疗法案》（ACA）将缩短住院时间并增加参保患者数量，同时不改变创伤患者的治疗结果。
对2012年至2014年期间入住一级创伤中心的成年创伤患者进行回顾性研究。分析了《平价医疗法案》实施前后的人口统计学数据、住院时间、付款人状态、出院处置情况及并发症。
研究期间共收治4448例创伤患者。《平价医疗法案》实施后接受治疗的患者年龄更大（53岁对51岁，p = 0.05），重症监护病房（ICU）住院时间更短（1.7天对1.5天，p = 0.04），但总体住院时间更长（3.7天对4.1天，p < 0.01）。自费患者比例从11%降至3%（p =<0.001）。更多患者出院后前往专业护理机构（SNF，17.1%对19.9%，p = 0.02）。死亡率、再入院率、感染率、肺炎或褥疮发生率没有变化。
在创伤患者中，实施《平价医疗法案》后，自费状态下降，公共保险增加，私人保险无变化。更多患者出院后前往专业护理机构，报告的治疗结果没有变化。
