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- (-) Access to Care (7)
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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 7 of 7 Research Studies DisplayedPorter A, Brown CC, Tilford JM
Association of insurance status with treatment and outcomes in pediatric patients with severe traumatic brain injury.
This study’s objective was to determine if a health insurance disparity exists among pediatric patients with severe traumatic brain injury using data from the National Trauma Data Bank. The Bank contains data from more than 800 trauma centers in the United States. Isolated traumatic brain injury was defined as patients with a head Abbreviated Injury Scale score of 3+. Procedure codes were used to identify four primary treatment approaches combined into 2 classifications: craniotomy or craniectomy and external or intracranial ventricular draining. Condition at admission was defined including hypotension, Glasgow Coma Scale, mechanism and intent of injury, and Injury Severity Scale. Among the cohort of 12,449 patients, 91% had insurance and 9% were uninsured. Children without insurance had worse condition at admission with higher rates of hypotension and higher Injury Severity Score when compared with publicly and privately insured patients. Having insurance was associated with a 32% increase in the odds of cranial procedures, and 54% increase in the odds of monitor placement. Insurance coverage was associated 25% lower odds of inpatient mortality. Further study is needed to determine what factors lead to worse condition at admission.
Citation: Porter A, Brown CC, Tilford JM .
Association of insurance status with treatment and outcomes in pediatric patients with severe traumatic brain injury.
Crit Care Med 2020 Jul;48(7):e584-e91. doi: 10.1097/ccm.0000000000004398..
Keywords: Children/Adolescents, Brain Injury, Trauma, Health Insurance, Access to Care, Uninsured, Outcomes
Jarman MP, Pollack Porter K, Curriero FC
Factors mediating demographic determinants of injury mortality.
The authors investigated the role of injury characteristics and access to trauma care as mediators of the relationships between race, ethnicity, sex, and injury mortality. They found that distance, injury characteristics, and insurance mediate the effects of demographic characteristics on injury mortality and appear to contribute to disparities in injury mortality.
AHRQ-funded; HS000029.
Citation: Jarman MP, Pollack Porter K, Curriero FC .
Factors mediating demographic determinants of injury mortality.
Ann Epidemiol 2019 Jun;34:58-64.e2. doi: 10.1016/j.annepidem.2019.03.013..
Keywords: Access to Care, Disparities, Injuries and Wounds, Mortality, Racial and Ethnic Minorities, Sex Factors, Social Determinants of Health, Trauma
Marcolini EG, Albrecht JS, Sethuraman KN
Gender disparities in trauma care: how sex determines treatment, behavior, and outcome.
This study used US and European trauma database statistics, including the National Trauma Databank, to examine sex disparities in trauma care. Their findings indicate that sex differences in risk-taking behaviors that lead to traumatic injury have been associated with males, with female menstrual cycle timing, and with cortisol levels. Differences in access to services at trauma centers, including triage or transfer and level of medical attention are associated with sex as well race, rural or urban location, and insurance status. Outcomes, such as in-hospital mortality, multiple organ failure, pneumonia, and sepsis are associated with sex disparities in the general trauma patient; outcomes after general trauma and specifically traumatic brain injury show mixed results.
AHRQ-funded; HS024560.
Citation: Marcolini EG, Albrecht JS, Sethuraman KN .
Gender disparities in trauma care: how sex determines treatment, behavior, and outcome.
Anesthesiol Clin 2019 Mar;37(1):107-17. doi: 10.1016/j.anclin.2018.09.007..
Keywords: Access to Care, Disparities, Injuries and Wounds, Outcomes, Patient-Centered Outcomes Research, Risk, Sex Factors, Trauma
Tung EL, Hampton DA, Kolak M
Race/ethnicity and geographic access to urban trauma care.
The goal of this study was to examine racial/ethnic differences in geographic access to trauma care in Chicago, Los Angeles, and New York City using census tract data from the 2015 American Community Survey. The role of residential segregation and neighborhood poverty was also considered. Small-area analyses were conducted to assess trauma desert status; ‘trauma desert’ was defined as a travel distance greater than 8 km to the nearest adult level I or level II trauma center. The results for each city’s census tracts and racial/ethnic categories were compared.
AHRQ-funded; HS023007.
Citation: Tung EL, Hampton DA, Kolak M .
Race/ethnicity and geographic access to urban trauma care.
JAMA Netw Open 2019 Mar;2(3):e190138. doi: 10.1001/jamanetworkopen.2019.0138..
Keywords: Racial and Ethnic Minorities, Urban Health, Access to Care, Trauma, Disparities
Jarman MP, Curriero FC, Haut ER
Associations of distance to trauma care, community income, and neighborhood median age with rates of injury mortality.
The purpose of this study was to examine the association of injury scene characteristics with injury mortality. The study concluded that injury scene characteristics are associated with injury mortality. The authors found that odds of death are highest for patients injured in communities with higher median age or lower per capita income and at locations farthest from level 1 or 2 trauma centers.
AHRQ-funded; HS000029.
Citation: Jarman MP, Curriero FC, Haut ER .
Associations of distance to trauma care, community income, and neighborhood median age with rates of injury mortality.
JAMA Surg 2018 Jun;153(6):535-43. doi: 10.1001/jamasurg.2017.6133..
Keywords: Access to Care, Mortality, Social Determinants of Health, Trauma, Injuries and Wounds
Carr BG, Bowman AJ, Wolff CS
Disparities in access to trauma care in the United States: a population-based analysis.
This study examined the association between geographic, demographic, and socioeconomic factors and trauma center access, with subgroup analyses of urban-rural disparities. It concluded that, while the majority of the United States has access to trauma care within an hour, almost 30 million US residents do not. Significant disparities in access were evident for vulnerable populations defined by insurance status, income, and rurality.
AHRQ-funded; HS017960.
Citation: Carr BG, Bowman AJ, Wolff CS .
Disparities in access to trauma care in the United States: a population-based analysis.
Injury 2017 Feb;48(2):332-38. doi: 10.1016/j.injury.2017.01.008.
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Keywords: Access to Care, Disparities, Health Services Research (HSR), Social Determinants of Health, Trauma
Shaw JJ, Psoinos CM, Santry HP
It's all about location, location, location: A new perspective on trauma transport.
The objective of this study was to determine the effect of aeromedical transport on trauma mortality when accounting for geographic factors. It concluded that helicopter transport does not impart a survival benefit for trauma patients when geographic considerations are taken into account.
AHRQ-funded; HS022694.
Citation: Shaw JJ, Psoinos CM, Santry HP .
It's all about location, location, location: A new perspective on trauma transport.
Ann Surg 2016 Feb;263(2):413-8. doi: 10.1097/sla.0000000000001265..
Keywords: Trauma, Emergency Medical Services (EMS), Registries, Mortality, Access to Care