Socioeconomic and geographic variation in response to trauma medical home intervention.

Abstract

Many injury survivors experience persistent biopsychosocial morbidity after hospital discharge. The trauma medical home (TMH), a multidisciplinary coordinated care model, demonstrated modest benefit in a multicenter randomized trial, but its effectiveness across rural and socioeconomically deprived populations remains unclear. This post hoc retrospective analysis of the TMH parent randomized trial included patients aged older than or equal to 50 years with an Injury Severity Score ≥9 across four level I trauma centers. For this study, patients were categorized by rurality and Area Deprivation Index (ADI). Outcomes included the SF-36 Physical and Mental Component Scores (PCS, MCS), depression [Patient Health Questionnaire-9 (PHQ-9)], anxiety [Generalized Anxiety Disorder (GAD-7)], physical function [Short Physical Performance Battery (SPPB)], and health care utilization. Interaction effects between TMH and rural/urban status or ADI were evaluated at baseline, 6 months, and 12 months. Four hundred thirty patients were included [216 TMH and 214 in usual care (UC)]. On the basis of urbanicity, the effectiveness of TMH on quality of life, psychological, physical, and health care utilization was similar at 6 and 12 months. ADI stratification showed greater differences. In high-ADI urban areas, baseline MCS scores were similar between TMH (47.5 ± 13.0) and UC (48.6 ± 12.8). By 6 months, TMH patients improved to 54.9 ± 8.8 compared with 49.0 ± 13.1 in UC, with a predicted difference of 7.7 (95% CI: 1.32, 12.83, P=0.016), demonstrating a clinically and statistically significant benefit of TMH. The TMH was associated with greater mental health improvement among patients with high area deprivation, particularly in urban settings, suggesting a potential role in reducing disparities through coordinated care. Level III, retrospective secondary analysis of a randomized trial.