The Association of Profit Status and Trauma Center Designation Burn Patient Racial/Ethnic Diversity and ED Transfers

Introduction: For-profit burn centers without trauma status may favor commercially insured patients, potentially resulting in minority patient underrepresentation. This study investigates profit status and trauma center designation in burn centers related to diversity of patients.

Methods: Using the California Healthcare Cost and Utilization Project Database, 2009-2019, all inpatient encounters at verified/non-verified burn centers were identified using ICD-9/10 and DRG codes. Primary outcomes included proportion of transfers with Medi-Cal or Uninsured and proportion of minority patients treated. Key covariates included safety-net, profit, and American Burn Association verification statuses, and American College Surgeons Level 1 trauma center designation. Adjusted covariates were burn size, gender, age, and payer type. Linear regression modeling was performed for individual burn centers, annually.

Results: In 12 burn centers over 11 years, the median proportion of Black and Hispanic patients treated per burn center per year was 44.7%, (IQR 37.4%, 53.2%). For-profit burn centers were negatively associated with proportion of Black and Hispanic patients treated (coef -9.2%, p=0.008); trauma centers were positively associated with higher proportion (coef 8.1%, p=0.011). Safety-net burn centers care for significantly more Medi-Cal patients (coef 9.9%, p=0.001). There were 0 ED-ED transfer for uninsured patients to for-profit burn centers, compared to 9 uninsured transfers to non-profit centers. There were 2 ED-ED transfer for Medi-Cal patients at for-profit centers versus 239 for non-profit burn centers.

Conclusion: To deliver higher equity burn care across the US, this study identifies disparities related to profit status and trauma center designation in burn centers, underscoring need for targeted, equity-based interventions and policy development.