Selection on observables and unobservables: Level I Trauma Center effects on return to work outcomes

Trauma accounts for twelve percent of Emergency Room visits in America. Level-I Trauma Centers provide care to persons with severe injury. Their specialization raises the possibility that they provide better care to patients there admitted than an equivalently injured person in a non-trauma hospital. MacKenzie et al (2006), using matching methods, showed that the risk of death is significantly lower when care is provided in a Level-I Trauma Center than in a non--trauma center. This dissertation explores whether for persons who were mainly working prior to their injury, was treatment at a trauma center more likely to result in their returning to work within 3 and within 12 months after injury.;Outcomes are compared among patients treated in 18 hospitals with a Level-I Trauma Center and 51 non--trauma center hospitals located in 12 states. Patients 18 to 64 years old with a moderate-to-severe injury and who were mainly working prior to injury were eligible. We use linear probability models and propensity-score weighting to adjust for observable differences between patients treated at trauma centers and those treated at non--trauma centers. We also use Instrumental Variables methods to adjust for unobservable differences between patients. Covariates include severity of injury, labor market conditions, and individual socio-economic characteristics. Data comes from the National Study on the Costs and Outcomes of Trauma (NSCOT) conducted between 2001 and 2002.;Using the percentage of people covered by helicopter transportation services at the state level as an instrument for the probability to be transported to a Level-I Trauma, we find that treatment at these centers improve the probability of returning to work within 3 months after injury by ten to twelve percentage points. These results are robust to sensitivity tests on specification and sample variation.