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Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response.  Labels: BACKGROUND, METHODS, RESULTS. Meshes: Female, Health Care Reform, Hospital Mortality, Hospitalization, Humans, Injury Severity Score, Insurance, Health, Length of Stay, Male, Mandatory Programs, Massachusetts, Middle Aged, Propensity Score, Retrospective Studies, Wounds and Injuries.
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Is mandatory health care insurance associated with shorter hospital length of stay among critically injured trauma patients? Context: The implementation of the Affordable Care Act stimulated interest in outcomes of patients in Massachusetts, a state mandating health insurance as of 2006. We sought to determine the impact of an insurance mandate on hospital use and outcomes among trauma intensive care unit (ICU) patients. This is a retrospective cohort study of trauma patients admitted to the ICU conducted at an academic, trauma center. Patients before (2004-2006) and after (2008-2012) the implementation of mandatory health insurance were compared using propensity matching to control for confounders. Outcomes were hospital length of stay (LOS), ICU LOS, in-hospital mortality, and discharge disposition. Overall, 1,668 trauma patients were included, with 530 matched on the propensity score in each group. Hospital LOS decreased by a median of 2.0 days, from 9.0 days (interquartile range, 4-15 days; p < 0.01) before to 7.0 days (interquartile range, 4-14) after implementation of the legislation. There were no differences in ICU LOS (3.0 days to 3.0 days, p = 0.44) and mortality (odds ratio [OR], 1.16; 95% confidence interval [CI], 0.83-1.63). Compared with discharges to home, the patients were more likely to be discharged home with home health services after the legislation (OR, 1.70; 95% CI, 1.08-2.68), but there was no significant change in the likelihoods of the patients being discharged to skilled nursing and rehabilitation facilities (OR, 0.97; 95% CI, 0.72-1.31).
assistant
Implementation of health care reform was associated with a decrease in hospital LOS, with an increase in use of home health services and no change in ICU LOS and mortality among trauma ICU patients at our institution. Final Decision: yes