Level-I Trauma Center Effects on Return-to-Work Outcomes

• Published in: Evaluation review 2012-04, Vol.36 (2), p.133-164
• Main Authors: Prada, Sergio I., Salkever, David, MacKenzie, Ellen J.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Age; Benefits; Case Records; Client Characteristics (Human Services); Colombia; Cost; Cost Effectiveness; Death; Demographics; Effectiveness studies; Female; Followup Studies; Health Care Costs; Health care expenditures; Health insurance; Health technology assessment; Hospital costs; Hospital treatment; Hospitals; Humans; Income; Injuries; Injury Severity Score; Male; Medical Care Evaluation; Medical service; Medical treatment; Middle Aged; Morbidity; Mortality; Multivariate Analysis; Occupational Health - economics; Occupational Health - statistics & numerical data; Outcomes of Treatment; Patients; Predictor Variables; Probability; Program Effectiveness; Propensity Score; Prospective Studies; Questionnaires; Rehabilitation Centers; Return to work programs; Risk; Surveys and Questionnaires; Trauma; Trauma care; Trauma centers; Trauma Centers - economics; Trauma Centers - statistics & numerical data; Treatment Outcome; U.S.A; United States; Vocational Rehabilitation; Work Capacity Evaluation; Wounds and Injuries - economics; Wounds and Injuries - rehabilitation; Young Adult
• ISSN: 0193-841X; 1552-3926
• DOI: 10.1177/0193841X12442674

Background: Injury is the leading cause of death for persons aged 1-44 years in the United States. Injuries have a substantial economic cost. For that reason, regional systems of trauma care in which the more acutely injured patients are transported to Level-I (L-I) trauma centers (TCs) has been widely advocated. However, the cost of TC care is high, raising questions about the value of such an approach. Objectives: To study L-I TC effectiveness and study return-to-work (RTW) outcomes. Research Design: Using data from National Study on the Costs and Outcomes of Trauma, the authors address the issue of selection bias by comparing naive estimates to matching techniques, as well as to nonlinear instrumental variable models (2SRI) and bivariate probit estimators. Subjects: Individuals ages 18-64 who were mainly working before traumatic injury. Patients selected for the study were treated at 69 hospitals located in 12 states in the United States. N = 1790. Measures: Treatment is binary indicator on whether treated at L-I TC. Outcome is binary indicator on whether returned to work within 3 months after injury. Covariates include: demographics, pre-injury characteristics (job, health and insurance status), injury descriptors, other income sources, etc. Results: Across all models that control for unobserved factors, the authors find that L-I TC treatment is positively associated with RTW within 3 months after injury. The estimated average marginal effect of treatment on the probability of RTW ranges from 23 to 38 percentage points. Conclusions: Benefits of L-I TC care extend beyond mortality and morbidity.