Disparities in Demographics and Outcomes Based on Trauma Center Ownership

Area of Science:

• Trauma surgery and healthcare management
• Health services research
• Health equity and disparities

Background:

• Trauma center (TC) ownership, for-profit (FP) versus not-for-profit (NFP), may influence operational strategies and patient demographics.
• FP TCs often prioritize favorable payor mixes for financial viability.
• NFP centers may rely on diverse funding streams including government support and patient volume.

Purpose of the Study:

• To investigate demographic differences in patients treated at FP versus NFP TCs.
• To examine associations between TC ownership type and patient outcomes, including length of stay, complications, and mortality.

Main Methods:

• Analysis of the Florida Agency for Health Care Administration (AHCA) inpatient dataset (2016-2017).
• Inclusion of 10,700 severely injured nonelderly adult trauma alert patients.
• Utilized negative binomial and logistic regression to compare outcomes based on TC ownership.

Main Results:

• Patients at FP TCs were less likely to be Black, uninsured, or have Medicare/Medicaid.
• FP TC patients had fewer comorbidities but experienced longer length of stay (LOS).
• FP TCs showed fewer reported complications but a higher likelihood of mortality (OR 1.70).

Conclusions:

• FP TCs serve a different patient demographic, with fewer underrepresented or publicly insured individuals.
• Despite fewer reported complications, FP TCs are associated with increased mortality and longer LOS in severe trauma patients.
• Ownership type is a significant factor influencing patient demographics and outcomes in trauma care.