平价医疗法案（Affordable Care Act）的医疗补助扩大计划与年轻创伤患者的二次过度转诊相关。
Association of the Affordable Care Act Medicaid Expansion With Secondary Overtriage among Young Adult Trauma Patients.
机构信息
Center for Surgical Outcomes Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Childrens Drive, Columbus, Ohio 43205; Center for Child Health Equity and Outcomes Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Childrens Drive, Columbus, Ohio 43205.
Center for Child Health Equity and Outcomes Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Childrens Drive, Columbus, Ohio 43205; Department of Pediatrics, College of Medicine, The Ohio State University, 370 West 9th Avenue, Columbus, Ohio 43210; Division of Health Services Management & Policy, College of Public Health, The Ohio State University, 1841 Neil Avenue, Columbus, Ohio 43210.
出版信息
J Surg Res. 2023 Mar;283:161-171. doi: 10.1016/j.jss.2022.10.057. Epub 2022 Nov 18.
BACKGROUND
Previous work has shown that the Affordable Care Act (ACA) Medicaid expansion decreased the uninsured rate and improved some trauma outcomes among young adult trauma patients, but no studies have investigated the impact of ACA Medicaid expansion on secondary overtriage, namely the unnecessary transfer of non-severely injured patients to tertiary trauma centers.
METHODS
Statewide hospital inpatient and emergency department discharge data from two Medicaid expansion and one non-expansion state were used to compare changes in insurance coverage and secondary overtriage among trauma patients aged 19-44 y transferred into a level I or II trauma center before (2011-2013) to after (2014-quarter 3, 2015) Medicaid expansion. Difference-in-difference (DD) analyses were used to compare changes overall, by race/ethnicity, and by ZIP code-level median income quartiles.
RESULTS
Medicaid expansion was associated with a decrease in the proportion of patients uninsured (DD: -4.3 percentage points; 95% confidence interval (CI): -7.4 to -1.2), an increase in the proportion of patients insured by Medicaid (DD: 8.2; 95% CI: 5.0 to 11.3), but no difference in the proportion of patients who experienced secondary overtriage (DD: -1.5; 95% CI: -4.8 to 1.8). There were no differences by race/ethnicity or community income level in the association of Medicaid expansion with secondary overtriage.
CONCLUSIONS
In the first 2 y after ACA Medicaid expansion, insurance coverage increased but secondary overtriage rates were unchanged among young adult trauma patients transferred to level I or II trauma centers.
背景
先前的研究表明，平价医疗法案（ACA）的医疗补助扩展计划降低了未参保率，并改善了年轻成年创伤患者的部分创伤结局，但尚无研究调查 ACA 医疗补助扩展计划对二级过度转诊的影响，即不必要地将非重伤患者转至三级创伤中心。
方法
本研究使用了来自两个医疗补助扩展州和一个非扩展州的全州医院住院和急诊部门出院数据，以比较在医疗补助扩展前（2011-2013 年）和后（2014 年第 3 季度至 2015 年），19-44 岁创伤患者的保险覆盖范围和二级过度转诊的变化，这些患者被转入一级或二级创伤中心。采用差值（DD）分析比较总体变化、按种族/族裔和按邮政编码中位数收入四分位数的变化。
结果
医疗补助扩展与未参保患者比例降低相关（DD：-4.3 个百分点；95%置信区间（CI）：-7.4 至-1.2），参保患者中医疗补助保险比例增加（DD：8.2；95%CI：5.0 至 11.3），但二级过度转诊患者比例无差异（DD：-1.5；95%CI：-4.8 至 1.8）。种族/族裔或社区收入水平与医疗补助扩展与二级过度转诊之间的关联无差异。
结论
在 ACA 医疗补助扩展后的头 2 年中，年轻成年创伤患者转入一级或二级创伤中心的保险覆盖范围增加，但二级过度转诊率不变。
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