The Probability of Hospitalizations for Mild-to-Moderate Injuries by Trauma Center Ownership Type

Authors

  • Etienne E. Pracht Ph.D.,

    Corresponding author
    1. Department of Health Policy and Management, College of Public Health, University of South Florida, Tampa, FL
    • Address correspondence to Etienne E. Pracht, Ph.D., Department of Health Policy and Management, College of Public Health, University of South Florida, 13201 Bruce B. Downs Boulevard, MDC 56, Tampa, FL 33612-3805; e-mail: epracht@health.usf.edu.

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  • Barbara Langland-Orban Ph.D.,

    1. Department of Health Policy and Management, College of Public Health, University of South Florida, Tampa, FL
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  • Jessica L. Ryan B.A.

    1. Department of Health Policy and Management, College of Public Health, University of South Florida, Tampa, FL
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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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