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.

National Institute of Health (NIH)
National Institute on Minority Health and Health Disparities (NIMHD)
Research Project (R01)
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Special Emphasis Panel (ZMD1-MLS (01))
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Dankwa-Mullan, Irene
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University of Massachusetts Medical School Worcester
Internal Medicine/Medicine
Schools of Medicine
United States
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Glance, Laurent G; Kellermann, Arthur L; Osler, Turner M et al. (2016) Impact of Risk Adjustment for Socioeconomic Status on Risk-adjusted Surgical Readmission Rates. Ann Surg 263:698-704
Osler, Turner; Glance, Laurent G; Li, Wenjun et al. (2015) Survival Rates in Trauma Patients Following Health Care Reform in Massachusetts. JAMA Surg 150:609-15
Osler, Turner; Glance, Laurent G; Li, Wenjun et al. (2015) Trauma care does not discriminate: The association of race and health insurance with mortality following traumatic injury. J Trauma Acute Care Surg 78:1026-33