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Effects of Affordable Care Act Medicaid Expansion on Disparities in Trauma Care and Outcomes in Young Adults

Award Number: R01MD013881
ORGANIZATION: NATIONAL CENTER ON MINORITY HEALTH AND HEALTH DISPARITIES
OPDIV: NIH
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

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Project Summary/Abstract Trauma is the leading cause of death and disability among young adults in the United States. Trauma affects all segments of the US population, but large disparities exist in access to high quality trauma care and outcomes after injury. Among young adults, uninsured patients, patients who reside in low income communities, and black patients have higher risk-adjusted rates of in-hospital mortality. Low income and black and Hispanic patients are also less likely to receive rehabilitative care after injury. These socioeconomic and racial/ethnic disparities are reduced among insured patients. Prior to the implementation of the Affordable Care Act (ACA), more than 20% of hospitalized trauma patients were uninsured, with this proportion being much higher among low income and racial/ethnic minority patients. Medicaid expansion through the ACA was implemented to increase health insurance coverage among low income adults. It has reduced the percentage of trauma patients who are uninsured. However, its effects nationally on the known socioeconomic and racial/ethnic disparities that exist in trauma care and outcomes remain unclear. Lack of insurance is not the only mechanism underlying these disparities as being uninsured is correlated with numerous factors that may independently affect trauma outcomes, such as poorer pre-injury health status, greater treatment delay, provider bias, and treatment at lower resourced hospitals. However, evidence for the direct impact of insurance coverage on disparities in trauma outcomes comes from populations with universal insurance coverage such as the elderly and military personnel, in whom these disparities are not seen. Further research is needed to understand the effect of ACA Medicaid expansion on racial/ethnic and socioeconomic disparities in trauma care and outcomes and elucidate the mechanisms by which this policy may have reduced these disparities. This project will utilize 2010-2017 State Inpatient and State Emergency Department Databases from 18 US states as well as data on hospital structural and financial characteristics to evaluate the effect of ACA Medicaid expansion on socioeconomic and racial/ethnic disparities in trauma care and outcomes among young adults hospitalized for injury. We aim to evaluate whether ACA Medicaid expansion has mitigated disparities in in- hospital mortality, transfer patterns, unplanned readmissions, and access to rehabilitative care after serious injury for Non-Hispanic black patients, Hispanic patients, and patients from low income communities. We also aim to determine what types of hospitals have experienced the largest improvements in outcomes among their minority and low socioeconomic status young adult trauma patients. This project will provide policy makers and healthcare providers with a clear picture of the impact of health insurance expansion to low income adults on racial/ethnic and socioeconomic disparities in trauma outcomes. With the federal government and states debating a variety of changes to Medicaid, this project will provide timely information on the potential effects of such policies on the hundreds of thousands of young adults seriously injured in the US each year.


Issue Date FY	Funding FY	Legal Entity Name	Legal Entity Address	Legal Entity City	Legal Entity State	Legal Entity Zip Code	Legal Entity COUNTY	Legal Entity COUNTRY	Assistance Listing	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2023 ( Subtotal = -$5,336 )
2023	2021	RESEARCH INSTITUTE AT NATIONWIDE CHILDREN'S HOSPITAL	700 CHILDRENS DR	COLUMBUS	OH	43205	FRANKLIN	USA	Minority Health and Health Disparities Research	000	3	4/24/2023	NON-COMPETING CONTINUATION	-$5,336
														Subtotal = -$5,336

Issue Date FY: 2021 ( Subtotal = $241,602 )
2021	2021	RESEARCH INSTITUTE AT NATIONWIDE CHILDREN'S HOSPITAL	700 CHILDRENS DR	COLUMBUS	OH	43205	FRANKLIN	USA	Minority Health and Health Disparities Research	001	3	3/15/2021	NON-COMPETING CONTINUATION	$24,160
2021	2021	RESEARCH INSTITUTE AT NATIONWIDE CHILDREN'S HOSPITAL	700 CHILDRENS DR	COLUMBUS	OH	43205	FRANKLIN	USA	Minority Health and Health Disparities Research	000	3	12/1/2020	NON-COMPETING CONTINUATION	$217,442
														Subtotal = $241,602

Issue Date FY: 2020 ( Subtotal = $241,602 )
2020	2020	RESEARCH INSTITUTE AT NATIONWIDE CHILDREN'S HOSPITAL	700 CHILDRENS DR	COLUMBUS	OH	43205	FRANKLIN	USA	Minority Health and Health Disparities Research	000	2	12/9/2019	NON-COMPETING CONTINUATION	$217,442
2020	2020	RESEARCH INSTITUTE AT NATIONWIDE CHILDREN'S HOSPITAL	700 CHILDRENS DR	COLUMBUS	OH	43205	FRANKLIN	USA	Minority Health and Health Disparities Research	001	2	1/10/2020	NON-COMPETING CONTINUATION	$24,160
														Subtotal = $241,602

Issue Date FY: 2019 ( Subtotal = $575,706 )
2019	2019	RESEARCH INSTITUTE AT NATIONWIDE CHILDREN'S HOSPITAL	700 CHILDRENS DR	COLUMBUS	OH	43205	FRANKLIN	USA	Minority Health and Health Disparities Research	000	1	4/26/2019	NEW	$575,706
														Subtotal = $575,706

Grand Total All Awards = $1,053,574

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Effects of Affordable Care Act Medicaid Expansion on Disparities in Trauma Care and Outcomes in Young Adults

Award Number: R01MD013881

ORGANIZATION: NATIONAL CENTER ON MINORITY HEALTH AND HEALTH DISPARITIES

OPDIV: NIH

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

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