Holzmacher Jeremy L, Townsend Kerry, Seavey Caleb, Gannon Stephanie, Schroeder Mary, Gondek Stephen, Collins Lois, Amdur Richard L, Sarani Babak
Center for Trauma and Critical Care, Department of Surgery, George Washington University, Washington, DC.
Department of Social Work, George Washington University Hospital, Washington, DC.
JAMA Surg. 2017 Oct 1;152(10):960-966. doi: 10.1001/jamasurg.2017.1720.
The expansion of Medicaid eligibility under the Affordable Care Act is a state-level decision that affects how patients with traumatic injury (trauma patients) interact with locoregional health care systems. Washington, DC; Maryland; and Virginia represent 3 unique payer systems with liberal, moderate, and no Medicaid expansion, respectively, under the Affordable Care Act. Characterizing the association of Medicaid expansion with hospitalization after injury is vital in the disposition planning for these patients.
To determine the association between expanded Medicaid eligibility under the Affordable Care Act and duration of hospitalization after injury.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study included patients admitted from Virginia, Maryland, and Washington, DC, to a single level I trauma center. Data were collected from January 1, 2013, through March 6, 2016, in Virginia and Washington, DC, and from May 1, 2013, through March 6, 2016, in Maryland. All patients with Medicare or Medicaid coverage and all uninsured patients were included. Patients with private insurance, patients with severe head or pelvic injuries, and those who died during hospitalization were excluded.
Hospital length of stay (LOS) and whether its association with patient insurance status varied by state of residence.
A total of 2314 patients (1541 men [66.6%] and 773 women [33.4%]; mean [SD] age, 52.9 [22.8] years) were enrolled in the study. The uninsured rate in the Washington, DC, cohort (190 of 1699 [11.2%]) was significantly lower compared with rates in the Virginia (141 of 296 [47.6%]) or the Maryland (106 of 319 [33.2%]) cohort (P < .001). On multivariate regression controlling for injury severity and demographic variables, the difference in LOS for Medicaid vs non-Medicaid recipients varied significantly by state. For Medicaid recipients, mean LOS in Washington, DC, was significantly shorter (2.57 days; 95% CI, 2.36-2.79 days) than in Maryland (3.51 days; 95% CI, 2.81-4.38 days; P = .02) or Virginia (3.9 days; 95% CI, 2.79-5.45 days; P = .05).
Expanded Medicaid eligibility is associated with shorter hospital LOS in mildly injured Medicaid recipients.
根据《平价医疗法案》扩大医疗补助资格是一项州级决策，会影响创伤患者与局部地区医疗保健系统的互动方式。华盛顿特区、马里兰州和弗吉尼亚州分别代表三种独特的支付者体系，在《平价医疗法案》下，它们对医疗补助的扩大程度分别为宽松、适度和未扩大。明确医疗补助扩大与受伤后住院之间的关联对于这些患者的处置规划至关重要。
确定《平价医疗法案》下扩大的医疗补助资格与受伤后住院时长之间的关联。
设计、设置和参与者：这项回顾性队列研究纳入了从弗吉尼亚州、马里兰州和华盛顿特区收治到一家一级创伤中心的患者。数据收集时间为2013年1月1日至2016年3月6日（弗吉尼亚州和华盛顿特区）以及2013年5月1日至2016年3月6日（马里兰州）。纳入所有有医疗保险或医疗补助覆盖的患者以及所有未参保患者。排除有私人保险的患者、有严重头部或骨盆损伤的患者以及住院期间死亡的患者。
住院时间（LOS）及其与患者保险状况的关联是否因居住州而异。
共有2314名患者（1541名男性[66.6%]和773名女性[33.4%]；平均[标准差]年龄为52.9[22.8]岁）纳入研究。华盛顿特区队列中的未参保率（1699人中的190人[11.2%]）显著低于弗吉尼亚州队列（296人中的141人[47.6%]）或马里兰州队列（319人中的106人[33.2%]）（P <.001）。在控制损伤严重程度和人口统计学变量的多变量回归分析中，医疗补助接受者与非医疗补助接受者的住院时间差异因州而异。对于医疗补助接受者，华盛顿特区的平均住院时间（2.57天；95%置信区间，2.36 - 2.79天）显著短于马里兰州（3.51天；95%置信区间，2.81 - 4.38天；P = 0.02）或弗吉尼亚州（3.9天；95%置信区间，2.79 - 5.45天；P = 0.05）。
扩大的医疗补助资格与轻度受伤的医疗补助接受者较短的住院时间相关。
