All ETDs from UAB

Advisory Committee Chair

Nancy Borkowski

Advisory Committee Members

Allyson G Hall

Larry Hearld

Geoffrey Silvera

John Mark Vermillion

Document Type


Date of Award


Degree Name by School

Executive Doctor of Science (DSc) School of Health Professions


This study examined the relationship of funding and the number of designated trauma centers and age-adjusted trauma mortality across the 50 states. State level funding was defined as monies that were paid to the designated trauma hospitals in aggregate by state and by year for the years 2008 to 2017. The number of designated trauma hospitals were considered in the categories of total number of state trauma hospitals and designation levels 1 through 4. Age-adjusted mortality included the ICD-10 codes for trauma from the WISQARS database. The strategic adaptation theory was used to inform the trauma hospital manager’s need to attain, maintain, increase/decrease designation or close the trauma hospital program. Two hypotheses were tested to consider the positive association between state level funding and the number of trauma hospitals in a state as well as the negative association between the number of trauma hospitals in a state and trauma related mortality. The study was completed using fixed effects panel regression analysis. Study findings showed an increase of 25.83% in Level 1 trauma hospitals in states that expanded Medicaid relative to the period prior to expansion. Each additional Level 3 trauma hospital in a state was associated with a .19 point increase in iv trauma related mortality in contrast to Level 4 hospitals where an additional one in a state was associated with a .25 point decrease in trauma related mortality.



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