Citation

Dvorak JE, Lester ELW, Maluso PJ, Tatebe LC, Bokhari F. J. Burn Care Res. 2020; ePub(ePub): ePub.

Copyright

(Copyright © 2020, American Burn Association, Publisher Lippincott Williams and Wilkins)

DOI

10.1093/jbcr/iraa116

PMID

32645149

Abstract

Uninsured and low socioeconomic status patients who suffer burn injuries have disproportionately worse morbidity and mortality. The Affordable Care Act was signed into law with the goal of increasing access to insurance, with Medicaid expansion in January 2014 having the largest impact. To analyze the population level impact of the Affordable Care Act on burn outcomes, and investigate its impact on identified at-risk subgroups, a retrospective time series of patients was created using data from the Healthcare Cost and Utilization Project National Inpatient Sample database between 2011 and 2016. An interrupted times series analysis was conducted to examine mortality, length of stay and the probabilities of discharge home, home with home health and to another facility before and after January 2014. There were no changes in burn mortality detected. There was a statistically significant reduction in the probability of being discharged home (-0.000967, p<0.01; 95% CI -0.0015379 - -0.0003962) or discharged home with home health (-0.000709, p<0.01; 95% CI -0.00110 - 0.000317) after 2014. There was an increase in the probability of being discharged to another facility (0.00108, p=0.01; 95% CI 0.000282 - 0.00188). While the enactment of the major provisions of the Affordable Care Act in 2014 was not associated with a changed in mortality for burn patients, it was associated with more patients being discharged to a facility: this may represent a significant improvement in access to care and rehabilitation. Future studies will assess the societal and economic impact of improved access to post-discharge facilities and rehabilitation.

Language: en

Keywords

Burns; Rehabilitation; Affordable Care Act; Burn Injuries; Burn Outcomes