Health Care Reform (HCR) is of paramount importance to the national agenda. This project will analyze the impact of Massachusetts (MA) HCR on disparities in the delivery and quality of trauma care and identify changes in care delivery infrastructure and policies that are critical for quality improvement, cost reduction and ultimate elimination of those disparities. Traumatic injuries are the leading cause of potential years of life lost before age 65 in MA and in the U.S. Each year in MA, trauma claims nearly 2,000 lives, and is associated with around 53,000 inpatient hospitalizations, and more than $2.5 billion acute care hospital charges. Previous analysis of pre-HCR MA healthcare data documented significant geographic, socioeconomic and racial/ethnic disparities in the delivery and outcomes of trauma care. This proposed investigation will focus on 5 groups of outcomes and quality indicators that are of clinical and policy significance, including 1) utilization, 2) mortality, 3) quality indicators, 4) discharge dispositions, and 5) cost of trauma care. Multi-level models will be used to analyze data routinely collected by MA government agencies between 2002 and 2011, including 1) Trauma Surveillance Systems, 2) Emergency Department Discharge Database, 3) Inpatient Hospital Discharge Database, 4) Outpatient Observation Stay Database, 5) Registry of Vital Records and Statistics, and 6) All Payers Claims Database. These databases are mandated by MA legislature.
The specific aims are:
Aim 1 : To determine the predictors, extent and temporal changes of disparities in the 5 groups of key outcomes and quality indicators, before and after the implementation of MA HCR;
Aim 2 : To determine the impact of MA HCR on the reduction of these disparities by comparing disparity indices and their components before and after the HCR, and Aim 3: To develop evidence-based recommendations on critical changes in infrastructure and trauma care policies to improve outcomes and eliminate disparities when HCR is already in place. The MA HCR law was enacted in 2006 to provide universal access to medical care and to improve health. However, little is known about whether this has actually improved health care utilization by economically marginalized populations, reduced disparities in the quality of care, and consequently improved health outcome. To our knowledge, such an investigation has not been carried out. This proposed investigation will thus fill a critical knowledge gap on the role of HCR in eliminating health care disparities by providing timely, unique, and valuable information to the current policy debate on national HCR.

Public Health Relevance

This project investigates the impact of Massachusetts health care reform on disparities in trauma care. The findings will fill a critical knowledge gap in the role of healthcare reform in elimination of health care disparities, adding timely, unique, and valuable information to the current policy debate on national health care reform.

Agency
National Institute of Health (NIH)
Institute
National Institute on Minority Health and Health Disparities (NIMHD)
Type
Research Project (R01)
Project #
5R01MD006231-02
Application #
8278550
Study Section
Special Emphasis Panel (ZMD1-MLS (01))
Program Officer
Alvidrez, Jennifer L
Project Start
2011-06-09
Project End
2014-03-31
Budget Start
2012-04-01
Budget End
2013-03-31
Support Year
2
Fiscal Year
2012
Total Cost
$401,509
Indirect Cost
$109,851
Name
University of Massachusetts Medical School Worcester
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
603847393
City
Worcester
State
MA
Country
United States
Zip Code
01655