Level-I trauma center effects on return-to-work outcomes.
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.


OBJECTIVE
To study L-I TC effectiveness and study return-to-work (RTW) outcomes.


METHODS
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.


METHODS
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.


METHODS
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.
Research Center for Social Protection and Health Economics (PROESA), University Icesi, Cali, Colombia. sprada@proesa.org.co
Sergio I
SI
Prada
David
D
Salkever
Ellen J
EJ
Mackenzie
D000293:Adolescent; D000328:Adult; D003105:Colombia; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016272:Occupational Health / Q000191:economics / Q000706:statistics & numerical data*; D057216:Propensity Score; D011446:Prospective Studies; D012306:Risk; D011795:Surveys and Questionnaires; D014193:Trauma Centers / Q000191:economics* / Q000706:statistics & numerical data; D016896:Treatment Outcome; D014938:Work Capacity Evaluation; D014947:Wounds and Injuries / Q000191:economics / Q000534:rehabilitation*; D055815:Young Adult