Socioeconomic and geographic variation in response to trauma medical home intervention.
Saba Ilkhani, Malaz Boustani, Emma Holler et al.
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In 30 seconds
This post hoc retrospective analysis of a multicenter randomized trial examined whether response to a trauma medical home (TMH) differed by rurality and area deprivation among adults aged 50 years or older with moderate-to-severe injury at four level I trauma centers. Among 430 participants, outcomes were generally similar between rural and urban groups. In high-deprivation urban areas, mental health scores improved more with TMH than usual care at 6 months: the predicted difference was 7.7 points (95% CI: 1.32, 12.83, P =0.016). The findings suggest variation in benefit by deprivation and setting.
Key findings
- Among 430 participants, TMH effectiveness across quality of life, psychological, physical, and health care utilization outcomes was similar by rural versus urban status at 6 and 12 months.
- In high-ADI urban areas, the predicted 6-month mental health score difference favoring TMH was 7.7 (95% CI: 1.32, 12.83, P =0.016).
Why it matters
Persistent biopsychosocial morbidity after injury can require coordinated follow-up. These results indicate that the benefits of a trauma medical home may not be uniform across populations, with a stronger mental health signal among patients in highly deprived urban areas. Understanding such variation may help inform evaluation of coordinated post-injury care and its potential role in addressing disparities.
What to keep in mind
This was a post hoc retrospective analysis of a parent randomized trial, and the reported subgroup benefit is specific to high-deprivation urban patients and the 6-month mental health outcome.