Vicente Jose Undurraga Perl1, Chris Dodgion2, Kyle Hart3, Bruce Ham4, Martin Schreiber5, David Thomas Martin6, David Zonies7. 1. Oregon Health & Science University, Department of Surgery, Portland, OR, USA. Electronic address: undurrag@ohsu.edu. 2. Oregon Health & Science University, Department of Surgery, Portland, OR, USA. Electronic address: cdodgion@gmail.com. 3. Oregon Health & Science University, Division of Trauma, Critical Care & Acute Surgery, Portland, OR, USA. 4. Oregon Health & Science University, Division of Trauma, Critical Care & Acute Surgery, Portland, OR, USA. Electronic address: hamb@ohsu.edu. 5. Oregon Health & Science University, Division of Trauma, Critical Care & Acute Surgery, Portland, OR, USA. Electronic address: schreibm@ohsu.edu. 6. Oregon Health & Science University, Division of Trauma, Critical Care & Acute Surgery, Portland, OR, USA. Electronic address: davethomasmartin@gmail.com. 7. Oregon Health & Science University, Division of Trauma, Critical Care & Acute Surgery, Portland, OR, USA. Electronic address: zonies@ohsu.edu.
Abstract
BACKGROUND: We hypothesized that the ACA would shorten length of stay and increase numbers of insured patients without changing trauma patient outcomes. METHODS: 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. RESULTS: 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. CONCLUSION: 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.
BACKGROUND: We hypothesized that the ACA would shorten length of stay and increase numbers of insured patients without changing traumapatient outcomes. METHODS: A retrospective review of adult traumapatients 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. RESULTS: 4448 traumapatients 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. CONCLUSION: Among traumapatients, 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.
Authors: Cheryl K Zogg; John W Scott; David Metcalfe; Abbe R Gluck; Gregory D Curfman; Kimberly A Davis; Justin B Dimick; Adil H Haider Journal: JAMA Surg Date: 2019-05-01 Impact factor: 14.766
Authors: Gregory A Metzger; Lindsey Asti; John P Quinn; Deena J Chisolm; Henry Xiang; Katherine J Deans; Jennifer N Cooper Journal: J Am Coll Surg Date: 2021-10-14 Impact factor: 6.113