TRAUMA CENTERS IN A MANAGED CARE ENVIRONMENT

Health care reform will affect the relationship of trauma centers to h ealth maintenance organizations and other managed care plans, We studi ed Kaiser Permanente Medical Center (Kaiser) members admitted to the T rauma Center at San Francisco General Hospital (SFGH) to determine: (1 ) variables predicting transfer from SFGH to a Kaiser Hospital (repatr iation), (2) the length of hospital stay (LOS), and (3) the cost of th eir care, The SFGH trauma registry provided data on 7,794 patients adm itted before 1994. To investigate LOS, 89 Kaiser patients over 1 year were matched with non-Kaiser patients on age, maximum Abbreviated Inju ry Scale score (MAIS) by body region, Injury Severity Score (ISS), hea d injury severity, and blunt or penetrating injury and disposition, Ka iser patients were significantly younger, more likely to have blunt in jury, and had a lower death rate, Significant predictors of repatriati on were an MAIS score greater than or equal to 3, abdominal or extremi ty injury, and an ISS score of 26 to 40, The mean LOS for all Kaiser p atients was 7.6 days, compared with 4.8 for controls (p = 0.20), Howev er, mean LOS was significantly longer in repatriated Kaiser patients c ompared with controls (16 vs, 7.8 days, p < 0.0005), Kaiser reimbursem ent rates were comparable with commercial payers, but higher than othe rs, A relatively small number of severely injured patients account for a large percentage of costly trauma care, Analyses of patient subsets are necessary for trauma centers to negotiate suitable relationships with managed care plans, A prospective study is needed to examine the cost efficiency of early transfer of managed care patients.