Haddad Diane N, Hatchimonji Justin, Kumar Satvika, Cannon Jeremy W, Reilly Patrick M, Kim Patrick, Kaufman Elinore
Division of Trauma, Surgical Critical Care and Emergency Surgery, Department of Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA.
University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
Trauma Surg Acute Care Open. 2024 Jul 15;9(1):e001417. doi: 10.1136/tsaco-2024-001417. eCollection 2024.
Although timely access to trauma center (TC) care for injured patients is essential, the proliferation of new TCs does not always improve outcomes. Hospitals may seek TC accreditation for financial reasons, rather than to address community or geographic need. Introducing new TCs risks degrading case and payer mix at established TCs. We hypothesized that newly accredited TCs would see a disproportionate share of commercially insured patients.
We collected data from all accredited adult TCs in Pennsylvania using the state trauma registry from 1999 to 2018. As state policy regarding supplemental reimbursement for underinsured patients changed in 2004, we compared patient characteristics and payer mix between TCs established before and after 2004. We used multivariable logistic regression to assess the relationship between payer and presentation to a new versus established TC in recent years.
Over time, there was a 40% increase in the number of TCs from 23 to 38. Of 326 204 patients from 2010 to 2018, a total of 43 621 (13.4%) were treated at 15 new TCs. New TCs treated more blunt trauma and less severely injured patients (p<0.001). In multivariable analysis, patients presenting to new TCs were more likely to have Medicare (OR 2.0, 95% CI 1.9 to 2.1) and commercial insurance (OR 1.6, 95% CI 1.5 to 1.6) compared with Medicaid. Over time, fewer patients at established TCs and more patients at new TCs had private insurance.
With the opening of new centers, payer mix changed unfavorably at established TCs. Trauma system development should consider community and regional needs, as well as impact on existing centers to ensure financial sustainability of TCs caring for vulnerable patients.
Level III, prognostic/epidemiological.
尽管及时为受伤患者提供创伤中心（TC）护理至关重要，但新的创伤中心不断增加并不总能改善治疗结果。医院可能出于财务原因寻求创伤中心认证，而非为了满足社区或地理需求。引入新的创伤中心有降低现有创伤中心病例和支付方组合质量的风险。我们推测新获得认证的创伤中心将接收不成比例的商业保险患者。
我们使用1999年至2018年的州创伤登记系统，收集了宾夕法尼亚州所有获得认证的成人创伤中心的数据。由于2004年该州关于为保险不足患者提供补充报销的政策发生了变化，我们比较了2004年之前和之后设立的创伤中心的患者特征和支付方组合。我们使用多变量逻辑回归来评估近年来支付方与前往新创伤中心或现有创伤中心就诊之间的关系。
随着时间的推移，创伤中心数量从23个增加到38个，增长了40%。在2010年至2018年的326204名患者中，共有43621名（13.4%）在15个新的创伤中心接受治疗。新的创伤中心治疗的钝性创伤患者更多，重伤患者更少（p<0.001）。在多变量分析中，与医疗补助患者相比，前往新创伤中心就诊的患者更有可能拥有医疗保险（比值比2.0，95%置信区间1.9至2.1）和商业保险（比值比1.6，95%置信区间1.5至1.6）。随着时间的推移，现有创伤中心的私人保险患者减少，新创伤中心的私人保险患者增加。
随着新中心的开设，现有创伤中心的支付方组合发生了不利变化。创伤系统的发展应考虑社区和区域需求，以及对现有中心的影响，以确保为弱势患者提供护理的创伤中心的财务可持续性。
三级，预后/流行病学。
