title: An evaluation of trauma outcomes related to insurance status in patients requiring prehospital helicopter transport.
abstract: BACKGROUND
  Disparities in access to medical care and outcomes of medical treatment related to insurance status are documented. However, little attention has been given to the effect of health care funding status on outcomes in trauma patients. Hypothesis/Problem This study evaluated if adult trauma patients who arrived by air transport to a trauma center had different clinical outcomes based on their health insurance status.
  
  
  METHODS
  A retrospective analysis was performed of all adult trauma patients arriving by prehospital flight services to a Level I Trauma Center over a 5-year period. Patients were classified as unfunded or funded based on health insurance status. Injury severity scores (ISS) were compared, while the end points evaluated in the study included duration of stay in the intensive care unit (ICU), duration of hospitalization, and mortality.
  
  
  RESULTS
  A total of 1,877 adult patients met inclusion criteria for the study, with 14% (n = 259) classified as unfunded and 86% (n = 1,618) classified as funded. Unfunded patients compared to funded patients had a significantly lower average ISS (12.82 vs 15.56; P < .001) but a significantly higher mortality rate (16.6% vs 10.7%; P < .01) and a 1.54 relative risk of death (95% CI, 1.136-2.098). Neither mean ICU stay (3.44 days vs 4.98 days; P = .264) nor duration of hospitalization (11.18 days vs 13.34 days; P = .382) was significantly different when controlling for ISS.
  
  
  CONCLUSIONS
  Unfunded health insurance status is associated with worse outcomes following less significant injury. Further investigation of baseline health disparities for identification and early intervention may improve outcomes. Additionally, these findings may have implications for the health systems of other countries that lack universal health care coverage.
authors.affiliation: 1University of Florida,College of Medicine - Jacksonville,Jacksonville,FloridaUSA.
authors.forename: Lori A
authors.initials: LA
authors.lastname: Gurien
authors.affiliation: 1University of Florida,College of Medicine - Jacksonville,Jacksonville,FloridaUSA.
authors.forename: David J
authors.initials: DJ
authors.lastname: Chesire
authors.affiliation: 2Mayo Clinic Florida,Jacksonville,FloridaUSA.
authors.forename: Stephanie L
authors.initials: SL
authors.lastname: Koonce
authors.affiliation: 1University of Florida,College of Medicine - Jacksonville,Jacksonville,FloridaUSA.
authors.forename: J Bracken
authors.initials: JB
authors.lastname: Burns
mesh_terms: D000328:Adult; D000368:Aged; D000401:Aircraft; D005260:Female; D005431:Florida; D017052:Hospital Mortality; D006801:Humans; D015601:Injury Severity Score; D019458:Insurance Coverage; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014193:Trauma Centers; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000401:mortality / Q000628:therapy*
keywords: ANCOVA analysis of covariance; ICU intensive care unit; ISS injury severity score; OECD Organization for Economic Co-operation and Development; trauma