The Affordable Care Act's Effect on Discharge Disposition of Racial Minority Trauma Patients in the United States.

Abstract

Our aim was to examine the US trauma population before and after the Affordable Care Act (ACA), specifically examining racial disparities in insurance status as well as access to post-hospitalization care in the trauma population. The National Trauma Data Bank was queried for all non-burn patients age 18 to 64. The patient data was grouped into pre-ACA (2012-2013) and post-ACA (2014-2015). Regression analysis was controlled for age, sex, race (when applicable), type of injury (blunt vs penetrating), ISS, shock, head injury, and mechanical ventilation and clustered by hospital. After ACA implementation, mortality decreased (2.4% from 2.6%, P < 0.001) and the number of patients discharged to acute care, nursing homes, and rehabilitation also decreased. Adjusting for age, sex, race, and injury-related variables associated with post-hospital care, the likelihood of discharge to acute care, skilled nursing, and rehab facilities decreased significantly post-ACA for all insurance and discharge destinations except those patients with private insurance discharging to rehab facilities. All uninsured patients as well as Caucasians with public insurance were more likely to die from their injuries than Caucasians with private insurance. After ACA, other minorities with private insurance had a higher mortality than privately-insured Caucasians. Despite an increase in the rate of insured trauma patients, after implementation of the affordable care act there was no increase in post-hospital care facility utilization, particularly for minorities. Uninsured trauma patients, who are more likely to be minorities, have not only decreased access to rehabilitation resources but also higher mortality.