title: Survival Rates in Trauma Patients Following Health Care Reform in Massachusetts.
abstract: OBJECTIVE
  Massachusetts introduced health care reform (HCR) in 2006, expecting to expand health insurance coverage and improve outcomes. Because traumatic injury is a common acute condition with important health, disability, and economic consequences, examination of the effect of HCR on patients hospitalized following injury may help inform the national HCR debate.
  
  
  OBJECTIVE
  To examine the effect of Massachusetts HCR on survival rates of injured patients.
  
  
  METHODS
  Retrospective cohort study of 1,520,599 patients hospitalized following traumatic injury in Massachusetts or New York during the 10 years (2002-2011) surrounding Massachusetts HCR using data from the State Inpatient Databases. We assessed the effect of HCR on mortality rates using a difference-in-differences approach to control for temporal trends in mortality.
  
  
  METHODS
  Health care reform in Massachusetts in 2006.
  
  
  METHODS
  Survival until hospital discharge.
  
  
  RESULTS
  During the 10-year study period, the rates of uninsured trauma patients in Massachusetts decreased steadily from 14.9% in 2002 to 5.0.% in 2011. In New York, the rates of uninsured trauma patients fell from 14.9% in 2002 to 10.5% in 2011. The risk-adjusted difference-in-difference assessment revealed a transient increase of 604 excess deaths (95% CI, 419-790) in Massachusetts in the 3 years following implementation of HCR.
  
  
  CONCLUSIONS
  Health care reform did not affect health insurance coverage for patients hospitalized following injury but was associated with a transient increase in adjusted mortality rates. Reducing mortality rates for acutely injured patients may require more comprehensive interventions than simply promoting health insurance coverage through legislation.
authors.affiliation: Department of Surgery, University of Vermont, Colchester.
authors.forename: Turner
authors.initials: T
authors.lastname: Osler
authors.affiliation: Department of Anesthesiology, University of Rochester, Rochester, New York.
authors.forename: Laurent G
authors.initials: LG
authors.lastname: Glance
authors.affiliation: Department of Medicine, University of Massachusetts Medical School, Worcester.
authors.forename: Wenjun
authors.initials: W
authors.lastname: Li
authors.affiliation: Department of Mathematics and Statistics, University of Vermont, Burlington.
authors.forename: Jeffery S
authors.initials: JS
authors.lastname: Buzas
authors.affiliation: School of Public Health and Health Sciences, University of Massachusetts, Worcester.
authors.forename: David W
authors.initials: DW
authors.lastname: Hosmer
mesh_terms: D000328:Adult; D005260:Female; D018166:Health Care Reform; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D017057:Medically Uninsured / Q000706:statistics & numerical data; D009518:New York / Q000453:epidemiology; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D015996:Survival Rate / Q000639:trends; D014947:Wounds and Injuries / Q000191:economics / Q000401:mortality*