Payer Source Associated with Disparities in Procedural, but Not Surgical, Care in a Trauma Population.

Trauma centers are legally bound by Emergency Medical Treatment and Active Labor Act to provide equal treatment to trauma patients, regardless of payer source. However, evidence has suggested that disparities in trauma care exist. This study investigated the relationships between payer source and procedures (total, diagnostic, and surgical) and the number of medical consults in an adult trauma population. This is a 10-year retrospective trauma registry study at a Level I trauma facility. Payer source of adult trauma patients was identified, demographics and variables associated with trauma outcomes were abstracted, and multivariate logistic regression tests were used to determine statistical differences in the number of procedures and medical consults. Of the 12,870 records analyzed, 69.1 per cent of patients were commercially insured, 21.2 per cent were uninsured, and 9.6 per cent had Medicaid. After controlling for patient- and injury-related variables, the commercially insured received more total procedures (4.30) than the uninsured (3.35) or those with Medicaid (3.34), and more diagnostic (2.59) procedures than the uninsured (2.03) or those with Medicaid (2.04). There was not a difference in the number of surgical procedures or medical consults among payer sources. This study noted that disparities (measured by the number of procedures received) compared by payer source existed in the care of trauma patients. However, for medical consults and definitive care (measured by surgical procedures), disparities were not observed. Future research should focus on secondary factors that influence levels of care such as patient-level factors (health literacy) and trauma program policies.

Youth empowerment implementation project evaluation results: A program designed to improve the health and well-being of low-income African-American adolescents.

Adolescent obesity is a major health issue facing today's youth. This may be the first generation to have a lower life expectancy than their parents. The Youth Empowerment Implementation Project's (YEIP) goal was to increase fruit and vegetable intake, lower junk food consumption, and increase physical activity among low-income African-American youth living in the Midwest. Thirty middle school aged youth participated in an evidenced-based program (i.e., Botvin's Life Skills Training) and were engaged in health education and physical activities. The results from baseline to follow-up demonstrated a reduction in junk food intake for participants and an increase in fruit and vegetable intake but not for physical activity. The health behaviors of participants improved for three out of four indicators following the intervention. Limitations, future research, and implications for future programs are also discussed.

The Impact of Payer Source on Trauma Outcomes in a Pediatric Population.

OBJECTIVES: Determine if there were differences in conclusions drawn regarding disparities in trauma outcomes based on literature-derived payer source definitions in a pediatric population. PATIENTS AND METHODS: Retrospective registry review of admitted pediatric trauma patients (≤17 years of age) at a level II pediatric trauma facility. Eligible patients were categorized into 3 payer source definitions: definition 1: commercially insured, Medicaid, uninsured; definition 2: insured, uninsured; definition 3: commercially insured, underinsured. Logistic regression was used to determine the influence of payer source on outcomes. RESULTS: Payer source was not significant in definition 1, 2, or 3 for intensive care unit length of stay (LOS), hospital LOS, medical consults, or mortality. For hospital disposition, payer source was significant in definition 1, the uninsured were 90% less likely than commercially insured to be discharged to continued care. In definition 2, the uninsured were 88% less likely than insured to be discharged to continued care. In definition 3, the underinsured were 57% less likely than commercially insured to be discharged to continued care. CONCLUSIONS: Differences between the literature-derived definitions were not observed and therefore conclusions drawn did not differ across definitions. The investigation demonstrated payer source was not associated with in-hospital outcomes (intensive care unit LOS, hospital LOS, medical consults, and mortality), but was with posthospital outcomes. Findings warrant future examinations on the categorization of payer source in pediatric patients and hospital disposition to gain a greater understanding of disparities related to payer source in pediatric trauma, specifically in terms of posthospital care.

Successes and Challenges of Optimal Trauma Care for Rural Family Physicians in Kansas.

INTRODUCTION: Kansas has a regionalized trauma system with formal mechanisms for review, however, increased communication with rural providers can uncover opportunities for system process improvement. Therefore, this qualitative study explored perceptions of family medicine physicians staffing emergency departments (ED) in rural areas, specifically to determine what is going well and what areas needed improvement in relation to the trauma system. METHODS: A focus group included Kansas rural family physicians recruited from a local symposium for family medicine physicians. Demographic information was collected via survey prior to the focus group session, which was audiotaped. Research team members read the transcription, identified themes, and grouped the findings into categories for analysis. RESULTS: Seven rural family medicine physicians participated in the focus group. The majority were male (71%) with the mean age 46.71 years. All saw patients in the ED and had treated injuries due to agriculture, falls, and motor vehicle collisions. Participants identified successes in the adoption and enforcement of standardized processes, specifically through level IV trauma center certification and staff requirements for Advanced Trauma Life Support training. Communication breakdown during patient discharge and skill maintenance were the most prevalent challenges. CONCLUSIONS: Even with an established regionalized trauma system in the state of Kansas, there continues to be opportunities for improvement. The challenges acknowledged by focus group participants may not be identified through patient case reviews (if conducted), therefore tertiary centers should conduct system reviews with referring hospitals regularly to improve systemic concerns.

Association of Injury Factors, Not Body Mass Index, With Hospital Resource Usage in Trauma Patients.

BACKGROUND: Allocating resources appropriately requires knowing whether obese patients use more resources during a hospital stay than nonobese patients. OBJECTIVES: To determine if trauma patients with different body mass indexes differed in use of resources measured as a multifaceted outcome variable. METHODS: A trauma registry was used for a retrospective study of adult patients admitted to a midwestern level I trauma center. Patients were stratified into 3 groups: nonobese (normal weight, overweight), obese, and morbidly obese. Three canonical correlation analyses were used to determine the relationship between patient/injury characteristics and hospital resource usage. RESULTS: In a sample of 9771 patients, 71.2% were non-obese, 23.8% obese, and 5.0% morbidly obese. For patient/injury characteristics, Injury Severity Score and physiological complications were significant variables for all 3 groups. Scores on the Glasgow Coma Scale were significant for nonobese patients only. For resource usage, intensive care unit length of stay and procedures were significant variables for all 3 groups. CONCLUSIONS: Associations between body mass index and outcomes have been noted when assessed as independent variables. However, when resource usage was assessed as a multifaceted outcome variable, injury factors (higher Injury Severity Score, lower scores on the Glasgow Coma Scale, more physiological complications) were associated with resource usage (increased length of stay in the intensive care unit and increased number of procedures). These findings provide clinicians a new perspective for evaluating the complex relationship between patient/injury characteristics and hospital resource usage.

The effect of methodology in determining disparities in in-hospital mortality of trauma patients based on payer source.

A retrospective registry review of adult patients admitted to a Level I trauma center sought to determine whether results regarding in-hospital mortality associated with payer source vary on the basis of methodology. Patients were categorized into 4 literature-derived definitions (Definition 1: insured and uninsured; Definition 2: commercially insured, publicly insured, and uninsured; Definition 3: commercially insured, Medicaid, Medicare, and uninsured; and Definition 4: commercially insured, Medicaid, and uninsured). In-hospital mortality differences were found in Definitions 2 and 3, and when reclassifying dual-eligible Medicare/Medicaid into socioeconomic and age indicators. Variations in methodology culminated in results that could be interpreted with differing conclusions.

Patient satisfaction with surgeons in a trauma population: testing a structural equation model using perceptions of interpersonal and technical care.

BACKGROUND: Research has shown that interpersonal care is positively associated with patient satisfaction. The literature is not as clear concerning patient perceptions of technical care. Evaluating patient satisfaction requires understanding the influence of patient perceptions of interpersonal and technical aspects of care. METHODS: This prospective, cross-sectional telephone survey examined the relationship between patient satisfaction, interpersonal care, and technical care. Respondents were asked to recall the trauma surgeon and then rate them for satisfaction with interpersonal and technical care. Patients were also asked to rate their global satisfaction (GS) with the healthcare. RESULTS: Structural equation modeling indicated that there was a significant direct effect of Interpersonal Care on Technical Care and Technical Care and Interpersonal Care on GS. Interpersonal care also had an indirect effect on GS though Technical Care. Fit indices showed that the hypothesized paths significantly improved the model. CONCLUSIONS: There were strong positive relationships between patient's perceptions of interpersonal care and technical care and GS. Patients that are unacquainted with technical aspects of care may make judgments based on satisfaction with interpersonal aspects of care. It is important that surgeons, even in a trauma environment, are aware of the strong relationship between patients' perceptions of interpersonal and technical care. Making efforts to focus on relationship-centered care will improve both personal and institutional satisfaction ratings. LEVEL OF EVIDENCE: III, epidemiological study.

Sexual attitudes and behaviors among adolescents.

The purpose of this article is to examine the self-reported sexual attitudes and behaviors of adolescents living in the Midwest. A survey was administered to 463 African American youths ages 11-19. The results indicate that intent to have sexual intercourse, reported likelihood toward having sexual intercourse, and whether participants felt that they would have sex in the next 3 months were predictors of whether they had sexual intercourse at the 3-month follow-up. The results also revealed that the opinions of referent others did not predict sexual intercourse at 3 months. Negative attitudes toward condoms did predict condom use at 3 months and the opinions of referent others also predicted condom use at 3 months. Limitations as well as future research are also discussed.

Substance use among African American adolescents in the Midwest.

The purpose of this article is to examine the attitudes and substance use behaviors of African American adolescents living in the Midwest. A baseline survey was administered to 463 African American teens between the ages of 11-19. The article examines the relationship between attitudes toward drugs and drug-using behavior in this African American sample. Drug use will be compared to national drug use norms established by the Youth Risk Behavior Surveillance Survey. Overall participants had fairly negative attitudes toward drugs. Sixty percent of the sample reported that they were committed to a drug-free life, 74% had made a decision to stay away from marijuana, 79% reported making a decision not to smoke cigarettes, and 71% reported they would not get drunk in the next year. Females were more likely to stay away from marijuana than males. In this current study there is cause for alarm; participants reported higher percentages of ever smoking cigarettes and marijuana than the Youth Risk Behavior Surveillance Survey. This study shows there is a need to provide substance abuse prevention programs for African American adolescents. Limitations and future directions are also discussed.

Promoting positive youth development by examining the career and educational aspirations of African American males: implications for designing educational programs.

African American males experience poor academic performance, high absenteeism at school, and are at increased risk of being involved in violence than other racial groups. Given that the educational outlook for African American males appears bleak, it is important to assess the aspirations of these adolescent males in order to find the gap between aspirations and educational attainment. In order to promote positive development within this population, it is essential that factors that affect African American males be identified. A survey was administered to male students attending elementary, middle, and high schools in a local school district. A cross-sectional study was conducted to examine the career and educational aspirations of African American males. A total of 473 males were surveyed: 45% African American, 22% Caucasian, 13% biracial, and 19% Other (including Asian American, Hispanic, Native American). The results revealed that African American males aspired to attend college at the same rate as other ethnic groups. Also, African American males were more likely to aspire to be professional athletes than males from other ethnic groups. Important factors to consider when designing a program are discussed as well as future research and limitations.

The power of aspirations and expectations: the connection between educational goals and risk behaviors among African American adolescents.

Numerous studies and interventions have been designed to either reduce the prevalence of risky behaviors (substance use, sexual activity, etc.) or increase the level of educational activity for adolescents. Research suggests that these two constructs may be related yet little is known about this relationship among African American youth. Archival data from the Risk Reduction Project was used to explore the connection between the protective factors of educational aspirations/expectations and recent participation in risky behavior. Results suggest that recent use of marijuana, alcohol to the point of intoxication, and sexual activity predicted lower aspirations and expectations among African American youth. From a positive youth development perspective, this study suggests the development of holistic interventions that build educational assets in youth, in addition to working to minimize risk behaviors. Limitations and suggestions for future research are also discussed.

Assessing the health behaviors of African American emerging adults.

The purpose of this article was to assess the overall health behaviors of African American emerging adults who live in a Midwestern city. Two hundred participants, ages 18-25, completed a 129-item survey. Results indicate that African American emerging adults are engaged in relatively healthy behaviors (i.e., physical activity, low substance use). The results also showed that within the emerging adult developmental period, there are differences in behavior for those who are in the younger (18-20) versus those that are older (21-25) in the developmental period. Limitations, future research, and implications for practice will also be discussed.