Disparities in Demographics and Outcomes Based on Trauma Center Ownership

Justine S Broecker; J L Ryan; Johanna McCracken; Barbara Langland-Orban; Astrid Botty Van den Bruele; Brian K Yorkgitis; Etienne Pracht; Marie Crandall

doi:10.1016/j.jss.2021.12.024

Disparities in Demographics and Outcomes Based on Trauma Center Ownership

J Surg Res. 2022 May:273:132-137. doi: 10.1016/j.jss.2021.12.024. Epub 2022 Jan 24.

Authors

Justine S Broecker¹, J L Ryan², Johanna McCracken³, Barbara Langland-Orban⁴, Astrid Botty Van den Bruele⁵, Brian K Yorkgitis⁶, Etienne Pracht⁴, Marie Crandall⁷

Affiliations

¹ Department of Surgery, Mayo Clinic Florida, Jacksonville, Florida.
² Department of Health Sciences and Administration, University of West Florida, Pensacola, Florida.
³ University of Florida College of Medicine, Gainesville, Florida.
⁴ College of Public Health, University of South Florida, Tampa, Florida.
⁵ Department of Surgery, Virginia Tech Carilion School of Medicine, Roanoke, Virginia.
⁶ Department of Surgery, University of Florida, Jacksonville, Florida.
⁷ Department of Surgery, University of Florida, Jacksonville, Florida. Electronic address: Marie.crandall@jax.ufl.edu.

PMID: 35085940
DOI: 10.1016/j.jss.2021.12.024

Abstract

Introduction: Ownership may influence trauma center (TC) location. For-profit (FP) TCs require a favorable payor mix to thrive, whereas not-for-profit (NFP) centers may rely on government funding, grants, and patient volume. We hypothesized that the demographics of trauma patients would be different for NFP and FP TCs due to ownership type. We also hypothesized that these demographic differences might be associated with outcomes such as length of stay, reported complications, and mortality.

Methods: We used the Florida Agency for Health Care Administration (AHCA) 2016-2017 inpatient dataset to examine differences in outcomes by trauma center ownership type. Negative binomial and logistical regression was used to compare trauma ownership, length of stay (LOS), reported complications, and mortality of severely injured nonelderly adult trauma patients.

Results: Our study analyzed risk factors and outcomes for 10,700 trauma alert patients. Patients treated at FP TCs were less likely to be Black (OR 0.70, 95% CI: 0.62-0.78), to be uninsured (OR 0.40, 95% CI 0.36-0.45), have Medicare (OR 0.53, 95% CI 0.43-0.66), or Medicaid (OR 0.57, 95% CI 0.50-0.65) (all P < 0.001). Patients treated at FP centers were less likely to have comorbidities (OR 0.89, 95% CI 0.82-0.96) and were associated with a longer LOS (0.10, 95% 0.05-0.15, P < 0.001) in nonelderly adult trauma patients. FP TCs were associated with fewer reported complications (OR 0.83, 95% CI 0.74-0.94) and were associated with a higher likelihood of mortality in nonelderly adults (OR 1.70, 95% CI 1.35-2.12, P < 0.001).

Conclusions: Among this cohort of severe International Classification of Diseases-based injury severity score (ICISS) patients, complications were less likely, but LOS and mortality were increased among FP TC patients. FP centers cared for fewer patients who were Black, uninsured, or who were Medicare/Medicaid/noncommercial insurance.

Keywords: Disparities; For-profit; Outcomes; Ownership; Quality; Trauma.

MeSH terms

Adult
Aged
Demography
Humans
Injury Severity Score
Medicare
Ownership
Retrospective Studies
Trauma Centers*
United States / epidemiology
Wounds and Injuries* / therapy