E. Kelly1, E. R. Kiemele2, G. Reznor1, J. M. Havens1, Z. Cooper1, A. Salim1 1Brigham And Women’s Hospital,Boston, MA, USA 2Harvard School Of Medicine,Brookline, MA, USA
Introduction:
Taken as a group, state trauma systems are associated with beneficial effects, such as reduction in mortality, but not all trauma systems are the same. Some states allocate a yearly budget in support of its system's activities, some states do not. It has not been shown that the benefits of a trauma system accrue equally to all states, or if the prescence of funding leads to beneficial effects not seen in states without a budget. It is also not known whether funding for a trauma system is associated with financial benefits that produce a return on the investment of budgetary funds. The objective of this study was to determine if f states with funded trauma systems are associated with an increase in access to trauma care (as defined as numbers of trauma centers per capita), or cost effectiveness of trauma care (as defined by numbers of trauma centers per Gross Domestic Product) compared to states without trauma system funding in place.
Methods:
A retrospective population based study was performed. Data for the number of verified trauma centers in 2010 were obtained from the American College of Surgeons (ACS) and for state-designated trauma centers from official reports from state departments of health. Only adult centers were examined. Populations and Gross Domestic Product (GDP) were obtained from the US Census. The main outcome measure was the number of trauma centers per state per population and per GDP. Statistical analysis was carried out using the Chi Square Test and Poisson Regression; p values <.05 were reported as significant.
Results:
There was no statistically significant correlation between the presence of a funded system and the numbers of Level 1 or Level 2 trauma centers. However, there was a statistically significance increase in the number of Level 3 centers in states with funded trauma systems per state GDP and population. In funded states, the number of Level 3 trauma centers per GDP and state population were 72.5±14.2/$100 Billion and 65.2±13.2/Million people compared to 4.31±1.7/$100 Billion and 1.60±0.60/Million people for non-funded states (p < 0.05). Poisson multivariate regression identified system funding as an independent predictor of number of Level 3 centers. Data expressed as mean ± SEM.
Conclusion:
Our study shows that the number of Level 3 trauma centers significantly and independently correlated with the presence of a funded trauma system. The number of Level 1 and 2 centers showed no such correlation. As Level 3 trauma centers are a key point of entry for trauma care, further study is warranted to determine if increased Level 3 access leads to improved time to definitive care or other clinical outcomes. Furthermore, our study shows that states that allocate funds for trauma systems operation have a greater number of Level 3 centers per dollar of GDP, even in states with lower tax bases, resulting in more cost efficient access.