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Level IV trauma centers should be able to provide the initial evaluation, assessment andresuscitation of injured patients. Patients with known or potentially serious injuries are to bestabilized and arrangements made for safe transfer to a larger facility with more resources. Thefacility should have 24-hour coverage by a physician; surgical coverage may not be available.These facilities are typically located in rural areas. Continuing education and preventionprograms are desirable.Trauma Service Areas and Regional Advisory CouncilsThe trauma services areas (TSAs) provide integration with local EMS agencies andtrauma hospitals. The Trauma Regional Advisory Councils (Trauma RACs) are responsible foroversight of EMS diversion criteria. The TDSHS maintains EMS and trauma registry databasesand has established rules for EMS and trauma oversight. The TDSHS certifies EmergencyMedical Technicians (EMT) and approves EMS providers (first responders, basic and advanced,and air vehicles). Oversight is provided by county or city government for 9-1-1 response.Trauma Care Use and OutcomesTrauma volume in Texas hospitals for 1999, 2000 and 2003 was estimated from Texashospital admission data. 2 Trauma patients were identified by principal ICD-9-CM diagnosiscode in the range 800.00 – 959.99, excluding 905-909 (late effects of injuries), 930-939 (effectsof foreign bodies entering through an orifice), 958 (traumatic complications), and 820.0-820.99 ifage >= 65 (hip fractures in the elderly). These are widely accepted codes for trauma cases. 15There has been an overall increase of 16.1% during the five year period (Table 1). As apercentage of total discharges, trauma admissions increased from 3% to 4%. Thecharacteristics of trauma cases has remained relatively stable over the period. The majority ofcases are adults age 18-64. The race/ethnicity distribution reflects that of the population. Aboutone third are commercially insured, 40% are covered by Medicare and Medicaid, and 15% areuninsured.2 Data problems prevented us from reporting estimates for 2001 and 2002.G-6
Table 1. Trauma Cases, 1999 – 20031999 2000 2003Total discharges 74,275 76,642 86,203Gender (%)Female 42.9 42.7 46.2Male 57.1 57.3 53.8Age (%)Children 0-17 15.6 15.1 15.3Adults 18 – 64 58.3 58.6 55.9Elderly 65 and older 26.1 26.4 28.7Race (%)American Indian/ .2 .1 .1Eskimo/AleutBlack (non-Hispanic) 10.5 10.4 9.6White (non-Hispanic) 58.4 58.5 60.0Hispanic 24.7 24.8 26.0Asian/Pacific .8 .8 .7IslanderOther 3.9 5.4 5.1Payment Source (%)Commercial36.5 36.1 32.9InsuranceMedicare 25.3 25.8 30.2Medicaid 8.8 8.4 11.5Other Government .3 .3 .3Other Private 6.4 6.4 5.0Uninsured/Self-pay 16.7 15.6 15.3Other 5.6 6.9 4.6Source: Texas Health Care Information Council, Hospital Discharge Survey xThe Injury Severity Score (ISS) is used to measure the severity of the patient’s injury.Table 2 shows the distribution of admissions by severity and outcome. Most cases fall in the 1-15 range of severity with 8-9% per year hospitalized for major trauma (ISS>15). Thepercentage of major trauma cases did not change over the period. Over 70% of all patientstreated were discharged home or to self-care expecting a full recovery. Approximately a fourthof the patients were transferred to another facility where their condition upon discharge isunknown. Only 2-3 % died before discharge or were discharged to hospice care.G-7
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Appendix ATask Force Members and St
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Hector Balcazar, Ph.D.Regional Dean
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Charles Haley, M.D., M.S.Medical Di
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Michael McKinney, M.D.Senior Execut
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M. Roy Wilson, M.D.PresidentTexas T
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Appendix BMedicaid and the State Ch
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services. There are two broad types
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Mandatory and Optional Covered Popu
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• Nurse-midwife services;• Fede
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Disproportionate Share Hospital Pro
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March 13, 2001, that limited the am
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year from FFY 2002-2004, $4.05 bill
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Medicaid beneficiaries. Section 191
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started in 2001 and 2002 to curb in
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urban and with fewer than 250,000 p
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Protection Act of 2000 and the Medi
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orientation). Recipients of Supplem
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enrollee is assigned a primary care
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Table 7. Texas Medicaid Policy Chan
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Table 8. Texas SCHIP Policy Changes
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families (through the employer’s
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share of the match must come from t
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Reinstating the Medically Needy Spe
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Endnotes1 Texas Health and Human Se
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35 Powers, Pyles, Sutter, and Vervi
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73 Office of Management and Budget,
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113 TexCare, Children’s Health In
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150 Lyndon B. Johnson School of Pub
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States by Groupings with Current El
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Medicaid and the State Children’s
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Graduate Medical Education ProgramA
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needs, however, there is a shortage
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15 Texas Association of Counties,
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ecording and evaluation; physical e
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Medicaid and the State Children’s
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ReferencesAmerican Academy of Pedia
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downloads/bipa.pdf#search='Medicare
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Texas Health and Human Services Com
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Appendix CAn Analysis of Reform Opt
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Encouraged by these low rates, Cong
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Establishing state-only tax incenti
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New York passed the Health Care Ref
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Hospital Cost Containment — Maryl
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dollar spent. 237 Texas spent almos
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Another option for small businesses
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• Medical equipment and supplies,
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pay the premiums for Medicaid benef
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Medicaid to children born after Sep
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Bill of Rights or “TABOR”; and
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The federal share for CHP+ is 65 pe
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SCHIP: increased eligibility in CHP
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• Medical equipment and supplies
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6. Funds obtained through the recov
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Status ReportMaineCare Program Expa
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the federal poverty level. 404 Sinc
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need their jobs as a source of empl
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Endnotes191 Deborah Chollet, Issue
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225 Ibid.226 Maryland Health Care C
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259 Kaiser Family Foundation, State
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SCHIP&subcategory=Medicaid+Spending
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325 Kaiser Family Foundation, State
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361 State Coverage Initiatives, Sta
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SCHIP&subcategory=SCHIP&topic=Feder
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An Analysis of Reform Options Devel
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ReferencesAdvantage Insurance and F
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Donnell-Kay Foundation. “Amendmen
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Kaiser Family Foundation. Demograph
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State Coverage Initiatives. Profile
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Appendix DLocal Initiatives to Expa
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with more coordinated services that
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FinancingSources of revenue include
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AdministrationThe Health and Hospit
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Until 1993, Denver Health (DH) was
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different benefit plans are offered
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Cost SharingPatient cost-sharing is
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management programs. I-Care promote
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the county indigent care plan. Bene
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Firstplan xxvi,12Moore County, Mich
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Benefits and ServicesEnrollees can
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EligibilityAs of 2005, enrollment i
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etween $23 and $120 per month. Ther
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Healthcare Accountability Act xxxvi
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Coordination - When health care age
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subsidized initiatives offer exposu
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arriers, two health plans attempted
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xxi Simmons, Sandy Coe, Gionfriddo,
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Table 1 (Continued). Local Care Ini
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Table 2 (Continued). Local Coverage
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Appendix EEducation and Health:A Re
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The human capital approach suggests
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etween standardized test scores (St
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INTRODUCTIONEducation plays a wide
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of children with chronic health con
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Implications. Given the current pre
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DiabetesPrevalence. Diabetes in chi
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Limitations. The cross-sectional de
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chronic lung disease, cystic fibros
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significant differences between tho
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Table 1. Prevalence of Selected Chr
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findings of lower test scores are b
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al (McKewen et al., 1998) report a
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Section 3. School-Based Interventio
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mathematics, science and oral expre
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Table 4. Summary of Research Findin
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etween SES and health is a dose-res
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Self-Rated Health. Evidence accumul
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economic hardship. One of the skill
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Education also improves the stabili
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sex in the expectation of a more pr
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TABLE 6. SUMMARY OF EXPLANATIONS FO
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According to the Census 2000 data,
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Policy Reports Recommendations (Tot
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Section 2. Recommendations on Schoo
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Childhood ConditionsSchool-based Pr
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Childhood ConditionsDiabetes (n=11)
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eduction in reading test scores com
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Table 10. Estimates of the Cost of
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National Asthma Education and Preve
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REFERENCESAck, M., Miller, I., & We
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Elo, I. T., & Preston, S. H. (1996)
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Kaemingk, K. L., Pasvogel, A. E., G
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Miller, D. S., & Miller, T. Q. (199
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Ross, C. E., & Wu, C. L. (1996). Ed
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Williams, D. R. (1990). Socioeconom
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SAMPLE, DESIGN, & INTERVENTIONACHIE
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SAMPLE, DESIGN, & INTERVENTIONStudy
Page 256 and 257: SAMPLE, DESIGN, & INTERVENTIONACHIE
Page 268 and 269: SICKLE CELL ANEMIAArmstrong(1996)SA
Page 272 and 273: SAMPLE, DESIGN, & INTERVENTIONSickl
Page 274 and 275: SAMPLE, DESIGN, & INTERVENTIONhemog
Page 278 and 279: SAMPLE, DESIGN, & INTERVENTIONStudy
Page 280 and 281: Curriculum Content: Statute §28.00
Page 282 and 283: • HEALTH PROMOTING ENVIRONMENTSch
Page 284 and 285: • COORDINATION/IMPLEMENTATIONCoor
Page 286 and 287: Education and Health: A Review and
Page 288 and 289: Appendix FState Regulation of Healt
Page 290 and 291: coverage they offer. 14 By 2004 onl
Page 292 and 293: poor health may make coverage more
Page 294 and 295: account for most, or even much, of
Page 296 and 297: More active state intervention in t
Page 298 and 299: Table 3 (GAO Appendix IV) shows whi
Page 300 and 301: Appendix GEmergency and Trauma Care
Page 302 and 303: The treatment of shock prior to sur
Page 304 and 305: the EMS needs in rural areas of the
Page 308 and 309: Table 2. Trends in Trauma Severity,
Page 310 and 311: the hospitals were on diversion or
Page 312 and 313: Representative Delisi was successfu
Page 314 and 315: Mental Health Access ChallengesCare
Page 316 and 317: fhttp://www.techproservices.net/his
Page 318 and 319: oohttp://www.saveourers.org/reports
Page 320 and 321: Appendix HBrief: Consulate ClinicDe
Page 322 and 323: In addition, the roundtable discuss
Page 324 and 325: clinic(s) affiliated with medical s
Page 326 and 327: Appendix ICommon Abbreviations
Page 328 and 329: HMOHRQOLHRSAICF/MRIHCTAIOMISSLBBLIU
Page 330 and 331: Appendix JPresentersDate/Location:
Page 332 and 333: Appendix KProvider Taxes: A Differe
Page 334: were previously categorized as char
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