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The probability of hospitalizations for mild-to-moderate injuries by trauma center ownership type
Journal article   Peer reviewed

The probability of hospitalizations for mild-to-moderate injuries by trauma center ownership type

Etienne E. Pracht, Barbara Langland-Orban and Jessica L. Ryan
Health Services Research, Vol.53, pp.35-48
53
2018
DOI: https://doi.org/10.1111/1475-6773.12646
PMCID: PMC5785306
PMID: 28074471
Web of Science ID: WOS:000423416400004

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Abstract

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.

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