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The Probability of Hospitalizations for Mild‐to‐Moderate Injuries by Trauma Center Ownership Type
Author(s) -
Pracht Etienne E.,
LanglandOrban Barbara,
Ryan Jessica L.
Publication year - 2018
Publication title -
health services research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.706
H-Index - 121
eISSN - 1475-6773
pISSN - 0017-9124
DOI - 10.1111/1475-6773.12646
Subject(s) - trauma center , medicine , confounding , logistic regression , emergency department , injury prevention , poison control , injury severity score , emergency medicine , occupational safety and health , demography , retrospective cohort study , medical emergency , surgery , psychiatry , pathology , sociology
Objective To corroborate anecdotal evidence with systematic evidence of a lower threshold for admission among for‐profit hospitals. Data Sources The study used Florida emergency department and hospital discharge datasets for 2012 to 2014. The treatment variable of interest was for‐profit‐designated trauma center status. The dependent variable indicated whether a patient with mild‐to‐moderate injuries was admitted after presenting as a trauma alert and then discharged to home. A separate analysis was conducted of discharges that had a 1‐day length of stay. Study Design Generalized estimation equations with logistic distribution models were used to control for the confounding influences and developed for four groups of patients: ICISS = 1 (no probability of mortality), ICISS ≥ 0.99, ICISS ≥ 0.95, and ICISS ≥ 0.85 (zero to 15 percent probability of mortality, which includes all mild and moderate injury patients). Principal Findings For the ICISS = 1 and ICISS ≥ 0.99 models, the centers' for‐profit status was the most important predictor. In the ICISS ≥ 0.95 and ICISS ≥ 0.85 models, injury type played a more important role, but for‐profit status remained important. For patients with a 1‐day stay, for‐profit status was associated with an even higher probability of hospitalization. Conclusions Considerable differences exist between for‐profit and not‐for‐profit trauma centers concerning hospitalization among the study population, which may be explained by supplier‐induced demand.