54.07 We Are What We Eat: Demographics And Payer Status Of Patients Presenting At Level I Trauma Centers

Posted on January 26, 2017

J. D. Forrester1, T. G. Weiser1, P. M. Maggio1, T. Browder1, L. Tennakoon1, D. A. Spain1, K. Staudenmayer1  1Stanford University,Department Of Surgery,Palo Alto, CA, USA

Introduction:
Trauma centers may face financial challenges as healthcare reimbursement changes. While American College of Surgeons level 1 trauma centers (ACSL1TCs) meet the same personnel and structural requirements, they often serve different populations. We hypothesized that differences between ACSL1TCs exist based on the patients they serve and some may be more sensitive to funding changes than others. 

Methods:
The National Trauma Data Bank 2014 was used to derive information on ACSL1TCs. Explorative cluster hypothesis generation was performed using Ward’s linkage, an agnostic, statistically robust clustering method to determine the expected number of clusters based on hospital, patient, and injury characteristics. Subsequent k-means clustering was applied for analysis.  Comparison between clusters was performed using Kruskall-Wallis or Chi2 where appropriate. 

Results:
In 2014, there were 113 ACSL1TCs that admitted 267,808 patients (median = 2220 patients, range: 928-6643 patients). Three clusters emerged. Cluster 1 centers (n=53, 47%) were more likely to admit older, Caucasian patients who suffered falls (P<0.05) and had higher proportions of private (31%) and Medicare payers (29%) (P=0.001) (figure). Cluster 2 centers (n=18, 16%) were more likely to admit younger, minority males who suffered penetrating trauma (P<0.05) and had higher proportions of Medicaid (24%) or self-pay patients (19%) (P=0.001). Cluster 3 centers (n=42, 37%) were similar to cluster 1 with respect to racial demographic and payer status but resembled cluster 2 centers with respect to injury patterns (P<0.05).

Conclusion:
Our analysis identified three clusters of ACSL1TCs serving three different patient populations. Given the variability in payer mix, some ACSL1TCs may be at higher risk for financial instability due to the changing reimbursement environment. Vulnerable centers, particularly those treating minorities with high rates of Medicaid and self-pay patients may require additional financial support to ensure they can continue to serve their missions.