Association of Medicaid Expansion Under the Affordable Care Act With Outcomes and Access to Rehabilitation in Young Adult Trauma Patients

Akande, Manzilat; Minneci, Peter C.; Deans, Katherine J.; Xiang, Henry; Cooper, Jennifer N.

doi:10.1001/jamasurg.2018.1630

Cited by 27 publications

(22 citation statements)

References 47 publications

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“…The largest gain in insurance coverage for trauma patients in our study occurred within the first 2 years of the ACA Medicaid expansion implementation, which largely explains why the increase in coverage after 4 years was not vastly different from that reported in previous studies that examined only the first 1 to 2 years of Medicaid expansion. 22 , 23 , 25 , 51 – 53 At the end of 2017, 32% of young adult trauma patients treated in non-expansion states were uninsured compared with only 9.7% of patients treated in expansion states. However, racial and ethnic disparities in insurance coverage persist nationally and among the young adult trauma patients in the Medicaid expansion states in this study, with 21% of Hispanic trauma patients in the included expansion states remaining uninsured in 2017 compared with 9.4% of Black patients and 7.1% of White patients.…”

Section: Discussionmentioning

confidence: 99%

“…Two multistate studies examining the first 1 to 2 years after ACA Medicaid expansion implementation found expansion to be associated with a decrease in uninsured rates, an increase in access to rehabilitation, and reductions in racial and socioeconomic disparities in some outcomes among nonelderly adult trauma patients. 22 , 23 Results from studies of individual Medicaid expansion states or trauma centers have indicated that although uninsured patients remain at an increased risk of mortality after trauma, the ACA Medicaid expansion has also led to a decrease in traumatic injury-related ED utilization and an increase in hospital revenue, particularly among safety net hospitals. Findings with regard to hospital length of stay among trauma patients have been mixed.…”

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confidence: 99%

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Association of the Affordable Care Act Medicaid Expansion with Trauma Outcomes and Access to Rehabilitation among Young Adults: Findings Overall, by Race and Ethnicity, and Community Income Level

Metzger

Asti

Quinn

et al. 2021

Journal of the American College of Surgeons

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BACKGROUND: Low-income young adults disproportionately experience traumatic injury and poor trauma outcomes. This study aimed to evaluate the effects of the Affordable Care Act's Medicaid expansion, in its first 4 years, on trauma care and outcomes in young adults, overall and by race, ethnicity, and ZIP code-level median income. STUDY DESIGN: Statewide hospital discharge data from 5 states that did and 5 states that did not implement Medicaid expansion were used to perform difference-in-difference (DD) analyses. Changes in insurance coverage and outcomes from before (2011-2013) to after (2014-2017) Medicaid expansion and open enrollment were examined in trauma patients aged 19 to 44 years. RESULTS:Medicaid expansion was associated with a decrease in the percentage of uninsured patients (DD e16.5 percentage points; 95% CI, e17.1 to e15.9 percentage points). This decrease was larger among Black patients but smaller among Hispanic patients than White patients. It was also larger among patients from lower-income ZIP codes (p < 0.05 for all). Medicaid expansion was associated with an increase in discharge to inpatient rehabilitation (DD 0.6 percentage points; 95% CI, 0.2 to 0.9 percentage points). This increase was larger among patients from the lowest-compared with highest-income ZIP codes (p < 0.05). Medicaid expansion was not associated with changes in in-hospital mortality or readmission or return ED visit rates overall, but was associated with decreased in-hospital mortality among Black patients (DD e0.4 percentage points; 95% CI, e0.8 to e0.1 percentage points). CONCLUSIONS: The Affordable Care Act Medicaid expansion, in its first 4 years, increased insurance coverage and access to rehabilitation among young adult trauma patients. It also reduced the socioeconomic disparity in inpatient rehabilitation access and the disparity in in-hospital mortality between Black and White patients.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Association of the Affordable Care Act Medicaid Expansion with Trauma Outcomes and Access to Rehabilitation among Young Adults: Findings Overall, by Race and Ethnicity, and Community Income Level

Metzger

Asti

Quinn

et al. 2021

Journal of the American College of Surgeons

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“…Insurance status is an important factor in determining a child's access to care and can affect the likelihood of being referred to a specialist [16] , [17] , [18] . More than 50% of the children that completed a telemedicine appointment in our study were covered through private insurance.…”

Section: Discussionmentioning

confidence: 99%

The value of telemedicine for the pediatric surgery patient in the time of COVID-19 and beyond

Metzger

Cooper

Lutz

et al. 2021

Journal of Pediatric Surgery

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Background : Prior to COVID-19, the use of telemedicine within pediatric surgery was uncommon. To curb the spread of the virus many institutions restricted non-emergent clinic appointments, resulting in an increase in telemedicine use. We examined the value of telemedicine for patients presenting to a pediatric surgery clinic before and after COVID-19 Methods Perspectives and the potential value of telemedicine were assessed by surveying patients or caregivers of patients being evaluated by a general pediatric surgeon in-person prior to COVID-19 and by patients or caregivers of patients who completed a telemedicine appointment with a pediatric surgical provider during the COVID-19 period. Results The pre-COVID survey was completed by 57 respondents and the post-COVID survey by 123. Most respondents were white and were caregivers 31-40 years of age. Prior to COVID-19, only 26% were familiar with telemedicine, 25% reported traveling more than 100 miles and >50% traveled more than 40 miles for their appointment. More than 25% estimated additional travel costs of at least $30 and in 43% of households, at least one adult had to miss time from work. Following a telemedicine appointment during the COVID-19 period, 76% reported the care received as excellent, 86% were very satisfied with their care, 87% reported the appointment was less stressful for their child than an in-person appointment, and 57% would choose a telemedicine appointment in the future. Conclusion For families seeking an alternative to the in-person encounter, telemedicine can provide added value over the traditional in-person encounter by reducing the burden of travel without compromising the quality of care. Telemedicine should be viewed as a viable option for pediatric surgery patients and future research directed toward optimizing the experience for patients and providers.

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“…Our study revealed that over 40% of trauma patients are discharged to rehabilitation postinjury, reflecting the urgent and increasing need for access to post-acute services, regardless of insurance status. [11][12][13] This is an underestimate of true need, as this does not include those patients who require post-acute care, but do not have access due to lack of insurance. As expected, patients with Medicare and private plans were more often discharged to rehabilitation, but this could not fully be explained by patient characteristics.…”

Section: Discussionmentioning

confidence: 99%

Interhospital variability in time to discharge to rehabilitation among insured trauma patients

Knowlton

Harris²,

Tennakoon³

et al. 2019

J Trauma Acute Care Surg

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Background: Hospital costs are partly a function of length of stay (LOS), which can be impacted by the local availability of post-acute care (PAC) resources (inpatient rehabilitation and skilled nursing facilities), particularly for injured patients. We hypothesized that LOS for trauma patients destined for PAC would be variable based on insurance type and hospitals from which they are discharged. Methods:We used the 2014-2015 National Inpatient Sample from the Healthcare Cost and Utilization Project (HCUP). We included all adult admissions with a primary diagnosis of trauma (ICD-9CM codes), who were insured and discharged to PAC. We then ranked hospitals based upon mean LOS and divided them into quartiles to determine differences. The primary outcome was inpatient LOS; secondary outcome was cost.Results: 958,005 trauma patients met inclusion criteria. Mean LOS varied based upon insurance type (Medicaid vs. Private vs. Medicare: 12.7 days vs. 8.8 and 5.7: p<0.001). Shortest LOS hospitals had a marginal variation in LOS (Medicaid vs. Private vs. Medicare: 5.5 days vs. 4.8 vs. 4.2, p<0.001). Longest LOS hospitals had mean LOS that varied substantially (16.4 vs. 11.0 vs. 6.7 days, p<0.001). Multivariate regression controlling for patient and hospital characteristics revealed that Medicaid patients spent Medicaid patients spent an additional 0.4 days in shortest LOS hospitals and an additional 2.6 days in longest LOS hospitals (p<0.001). The average daily

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Association of Medicaid Expansion Under the Affordable Care Act With Outcomes and Access to Rehabilitation in Young Adult Trauma Patients

Cited by 27 publications

References 47 publications

Association of the Affordable Care Act Medicaid Expansion with Trauma Outcomes and Access to Rehabilitation among Young Adults: Findings Overall, by Race and Ethnicity, and Community Income Level

Association of the Affordable Care Act Medicaid Expansion with Trauma Outcomes and Access to Rehabilitation among Young Adults: Findings Overall, by Race and Ethnicity, and Community Income Level

The value of telemedicine for the pediatric surgery patient in the time of COVID-19 and beyond

Interhospital variability in time to discharge to rehabilitation among insured trauma patients

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