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Smith CB, Schneider A, Johnson D, Charles A, Gallaher J. Racial and ethnic disparities in discharge planning among trauma patients in the United States. Am J Surg 2025; 245:116352. [PMID: 40279861 DOI: 10.1016/j.amjsurg.2025.116352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2024] [Revised: 03/17/2025] [Accepted: 04/17/2025] [Indexed: 04/29/2025]
Abstract
INTRODUCTION Trauma patients often require post-discharge services, including home health, nursing care, or inpatient rehabilitation, but disparities may exist. METHODS We analyzed the US National Trauma Data Bank (2011-2021). Insured patients that survived to discharge were stratified by race and ethnicity (non-Hispanic White; non-Hispanic Black; Hispanic; non-Hispanic Asian), and propensity score matched based on age, sex, insurance type, Charlson Comorbidity Index, and Injury Severity Score (ISS). An ordered logistic regression was performed on the matched cohorts to estimate the odds ratio of receiving a higher level of discharge services compared to white patients. RESULTS We analyzed 7,172,601 patients. Race and ethnicity composition was 72.8 % non-Hispanic White, 14.6 % non-Hispanic Black, 10.4 % Hispanic, and 2.2 % non-Hispanic Asian. Compared to White patients, for non-Hispanic Black patients, the odds ratio of a higher level of discharge services was 0.84 (0.84, 0.85); for Hispanic patients, 0.76 (0.75, 0.76); and for non-Hispanic Asian patients, 0.85 (0.84, 0.86). CONCLUSIONS In a propensity-matched cohort, all analyzed minority groups had lower odds of receiving a higher level of discharge services than White patients.
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Affiliation(s)
- Charlotte B Smith
- Division of Trauma and Acute Care Surgery, Department of Surgery, University of North Carolina at Chapel Hill, North Carolina, USA
| | - Andrew Schneider
- Division of Trauma and Acute Care Surgery, Department of Surgery, University of North Carolina at Chapel Hill, North Carolina, USA
| | - Daryhl Johnson
- Division of Trauma and Acute Care Surgery, Department of Surgery, University of North Carolina at Chapel Hill, North Carolina, USA
| | - Anthony Charles
- Division of Trauma and Acute Care Surgery, Department of Surgery, University of North Carolina at Chapel Hill, North Carolina, USA
| | - Jared Gallaher
- Division of Trauma and Acute Care Surgery, Department of Surgery, University of North Carolina at Chapel Hill, North Carolina, USA.
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Velásquez-Cano M, Noordzij R, Carnevale C, Shepler LJ, Tenney-Laperriere D, Kazis LE, Ryan CM, Slavin MD, Schneider JC. REsource Support To Optimize REcovery (RESTORE) scoping review: Evaluating aftercare resources for burn survivors. Burns 2025; 51:107350. [PMID: 39721091 PMCID: PMC11755982 DOI: 10.1016/j.burns.2024.107350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2024] [Revised: 11/27/2024] [Accepted: 12/10/2024] [Indexed: 12/28/2024]
Abstract
BACKGROUND Burn survivors report limited resources as they transition to their communities after initial hospitalization. The aim of this project is to review literature that identifies resources provided to burn survivors and their supporters after discharge to their communities. METHODS The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines were used to examine the following literature databases: PubMed, EMBASE, Web of Science, PsycInfo, and CINAHL. The World Health Organization (WHO) International Classification of Functioning, Disability and Health (ICF) Core Set for burn injury provided a framework to categorize resource content. RESULTS Of the 637 articles screened, 27 met inclusion criteria. Data extraction identified resources categorized into the following ICF components: Body Functions, Activities and Participation, and Environmental Factors. CONCLUSION This review uses a conceptual framework to provide an overview of current published resources to support burn survivors following hospitalization. The identified resources addressed content such as health professionals, programs, psychological functioning after burn injury, scar management, and virtual resources. Based on the ICF framework, some gaps in resource content were noted such as pain, thermoregulation, interpersonal relationships, and self-care. Findings reveal relative strengths and gaps in resources, which can be used to better support burn survivors following hospitalization.
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Affiliation(s)
- Mariana Velásquez-Cano
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA, USA
| | - Renee Noordzij
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA, USA; Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Camille Carnevale
- Massachusetts General Hospital Institute of Health Professions, Boston, MA, USA
| | - Lauren J Shepler
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA, USA
| | | | - Lewis E Kazis
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA, USA; Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA; Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA
| | - Colleen M Ryan
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA, USA; Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA; Department of Surgery, Massachusetts General Hospital, Boston, MA, USA; Shriners Hospitals for Children-Boston®, Boston, MA, USA
| | - Mary D Slavin
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA, USA; Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA; Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA
| | - Jeffrey C Schneider
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA, USA; Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA.
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Jawad AM, Kadhum M, Evans J, Cubitt JJ, Martin N. Recovery of functional independence following major burn: A systematic review. Burns 2024; 50:1406-1423. [PMID: 38492981 DOI: 10.1016/j.burns.2024.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 01/07/2024] [Accepted: 02/21/2024] [Indexed: 03/18/2024]
Abstract
BACKGROUND Major burn injury, despite advancements in care and prevention, can have a profound impact on long-term morbidity, affecting quality of life and socioeconomic standing. We aim to explore factors predicting recovery of independence, the expected rate and time in majorly burned patients, and the measures of progress used. METHOD A systematic search of four databases (MEDLINE, EMBASE, COCHRANE, CINAHL) was conducted for studies reporting outcomes pertaining to physical ability indicative of independent function in adult (>15 y) cohorts who had suffered a major burn (>20% TBSA) up to 30 years after treatment in a developed specialised burn service. Data extracted included factors affecting rate of and time to achievement of function in five independence domains, as well as the outcome measures used. RESULTS 21 eligible studies were included comprising 1298 major burns survivors with a combined mean age of 39.6 y and a mean TBSA of 25.8%. The most significant recurring factors impacting recovery of independent function were older age, female gender, burn severity, prolonged ICU and hospital admission, preceding mental health conditions, and post-acute psychological issues. Exercise-based rehabilitation conferred benefits on major burn patients even over 2 years following injury. Discharge to independent living from hospital occurred in 27% to 97% of patients, while reported return to work rates varied from 52% to 80%. Burns Specific Health Scale-Brief, Functional Independence Measure, and Physical Composite Score (SF-36) were the most widely used outcome scoring systems. CONCLUSION Major burn survivors have protracted recovery with potential for persistent chronic impairments, remaining consistently below baseline levels of function. Non-modifiable factors such as age and gender, and disease characteristics such as burn size with associated physical, physiological and psychosocial sequelae are contributory. Further research is required to explore achievement of specific milestones of major burn and polytrauma critical care patients, while early targeted rehabilitation addressing physical, psychological, and vocational needs has promising potential benefit.
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Affiliation(s)
- Ali M Jawad
- Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, UK; Welsh Centre for Burns and Plastic Surgery, Swansea, Wales, UK.
| | - Murtaza Kadhum
- Welsh Centre for Burns and Plastic Surgery, Swansea, Wales, UK
| | - Janine Evans
- Welsh Centre for Burns and Plastic Surgery, Swansea, Wales, UK
| | | | - Niall Martin
- Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, UK
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Young MJ. Disorders of Consciousness Rehabilitation: Ethical Dimensions and Epistemic Dilemmas. Phys Med Rehabil Clin N Am 2024; 35:209-221. [PMID: 37993190 DOI: 10.1016/j.pmr.2023.06.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
Patients with disorders of consciousness who survive to discharge following severe acute brain injury may face profoundly complex medical, ethical, and psychosocial challenges during their courses of recovery and rehabilitation. Although issues encountered in caring for such patients during acute hospitalization have received substantial attention, ethical challenges that may arise in subacute and chronic phases have been underexplored. Shedding light on these issues, this article explores the landscape of normative issues in the course of treating and facilitating access to care for persons with disorders of consciousness during rehabilitation and examines potential implications for patients, clinicians, family members, and society.
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Affiliation(s)
- Michael J Young
- Department of Neurology, Massachusetts General Hospital, Center for Neurotechnology and Neurorecovery, 101 Merrimac Street, Suite 310, Boston, MA 02114, USA.
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5
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Twichell M. Inpatient Rehabilitation Following Burn Injury. Phys Med Rehabil Clin N Am 2023; 34:755-765. [PMID: 37806695 DOI: 10.1016/j.pmr.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
Inpatient rehabilitation confers excellent benefit to burn survivors and should be considered as a potential destination during discharge planning. Consulting physiatrists identify and manage complications within the inpatient rehabilitation setting. Interventions can be taken to address medical sequelae of injury, including pain, itch, neuropathy, psychological coping and mood, and nutritional needs. Physiatrists also oversee and direct a rehabilitation program focusing on scar management, contracture prevention, dysphagia treatment, and evaluation and treatment of cognitive impairments. Aerobic and resistive exercise are key components of an inpatient rehabilitation program to reduce the systemic impact of a burn injury and improve quality of life.
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Affiliation(s)
- Maria Twichell
- Department of Physical Medicine and Rehabilitation, School of Medicine, University of Pittsburgh, 3471 Fifth Avenue, Suite 910, Pittsburgh, PA 15213, USA.
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Kowalske K. Evolution of Burn Rehabilitation. Phys Med Rehabil Clin N Am 2023; 34:xv-xvi. [PMID: 37806706 DOI: 10.1016/j.pmr.2023.06.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Affiliation(s)
- Karen Kowalske
- Department of Physical Medicine and Rehabilitation, University of Texas, Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-9055, USA.
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Galicia KE, Mehta A, Riviello R, Nitzschke S, Bamer A, Gibran NS, Stewart BT, Wolf SE, Ryan CM, Kubasiak J, Schneider JC. The Effect of Distance to Treatment Center on Long-Term Outcomes of Burn Patients. J Burn Care Res 2023; 44:624-630. [PMID: 35939346 PMCID: PMC9905382 DOI: 10.1093/jbcr/irac112] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Indexed: 11/13/2022]
Abstract
Geospatial proximity to American Burn Association (ABA)-verified burn centers or self-designated burn care facilities varies across the country. This study evaluates the effect of distance to treatment center on long-term, patient-reported outcomes. Data from the Burn Model System (BMS) National Longitudinal Database were analyzed. Demographic and clinical data were compared between three cohorts stratified by distance to BMS center (<20, 20-49.9, ≥50 miles). Distance to BMS center was calculated as driving distance between discharge and BMS center ZIP code centroids. The following patient-reported outcomes, collected at 12-months follow-up, were examined: Veterans RAND 12-Item Health Survey (VR-12), Satisfaction with Life (SWL) scale, employment status, and days to return to work. Mixed model regression analyses were used to examine the associations between distance to BMS center and each outcome, controlling for demographic and clinical variables. Of 726 patients included in this study, 26.3% and 28.1% were <20 and between 20 and 49.9 miles to a BMS center, respectively; 46.6% were ≥50 miles to a BMS center. Greater distance was associated with white/non-Hispanic race/ethnicity, preinjury employment, flame injury, and larger burn size (P < .001). Regression analyses did not identify significant associations between distance to BMS center and any patient-reported outcomes. This study suggests that patients treated at BMS centers have similar long-term, patient-reported outcomes of physical and psychosocial function, as well as employment, despite centralization of burn care and rehabilitation services. Given a steady decline in the incidence of burn injury, continued concentration of key resources is logical and safe.
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Affiliation(s)
- Kevin E Galicia
- Address correspondence to Kevin E. Galicia, MD, Department of Surgery, Loyola University Medical Center, 2160 S. First Ave, Maywood, IL 60153, USA.
| | - Anupama Mehta
- Division of Trauma, Burn, and Surgical Care, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Robert Riviello
- Division of Trauma, Burn, and Surgical Care, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Stephanie Nitzschke
- Division of Trauma, Burn, and Surgical Care, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Alyssa Bamer
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | - Nicole S Gibran
- Department of Surgery, The University of Washington, Seattle, Washington, USA
| | - Barclay T Stewart
- Department of Surgery, The University of Washington, Seattle, Washington, USA
| | - Steven E Wolf
- Division of Burn and Trauma Surgery, University of Texas Medical Branch, Galveston, Texas, USA
| | - Colleen M Ryan
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - John Kubasiak
- Department of Surgery, Loyola University Medical Center, Maywood, Illinois, USA
| | - Jeffrey C Schneider
- Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA
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Kelter BM, Wolfe AE, Kazis LE, Ryan CM, Acton A, Slavin MD, Schneider JC. Trajectory Curves for Purposes of Benchmarking and Predicting Clinical Outcomes: A Scoping Review. J Burn Care Res 2022; 43:1095-1104. [PMID: 34986488 PMCID: PMC9255662 DOI: 10.1093/jbcr/irab245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Trajectory curves are valuable tools to benchmark patient health status and predict future outcomes. A longitudinal study is underway to examine social participation after burn injury using the Life Impact Burn Recovery Evaluation (LIBRE) Profile with the goal of developing trajectory curves for specific domains that focus on social reintegration. We conducted a scoping review to inform and understand trajectory curves applied in clinical settings to compare outcomes for an individual to a matched cohort of comparable patients or predicted expected outcomes over time. This scoping review utilized a PubMed search from January 2014 to August 2019 for the following terms: "trajectory curves" or "trajectory models" and "clinic" or "clinical." Only articles that specifically referenced longitudinal and clinical research designs were included in the scoping review. Articles were assessed using standard scoping review methods and categorized based on clinical application of trajectory curves for either benchmarking or prediction. The initial literature review identified 141 manuscripts and 34 met initial inclusion criteria. The reviewed articles support the clinical use of trajectory curves. Findings provide insight into several key determinants involved with the successful development and implementation of trajectory curves in clinical settings. These findings will inform efforts to use the LIBRE Profile to model social participation recovery and assist in developing effective strategies using trajectory curves to promote social reintegration after burn injury.
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Affiliation(s)
- Brian M Kelter
- Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Physical Medicine & Rehabilitation, Spaulding Research Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Audrey E Wolfe
- Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Physical Medicine & Rehabilitation, Spaulding Research Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Lewis E Kazis
- Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Physical Medicine & Rehabilitation, Spaulding Research Institute, Harvard Medical School, Boston, Massachusetts, USA
- Department of Health Law, Policy and Management, Boston University School of Public Health, Massachusetts, USA
| | - Colleen M Ryan
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, USA
- Department of Surgery, Shriners Hospitals for Children—Boston®, Massachusetts, USA
| | - Amy Acton
- Phoenix Society for Burn Survivors, Grand Rapids, Michigan, USA
| | - Mary D Slavin
- Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Physical Medicine & Rehabilitation, Spaulding Research Institute, Harvard Medical School, Boston, Massachusetts, USA
- Department of Health Law, Policy and Management, Boston University School of Public Health, Massachusetts, USA
| | - Jeffrey C Schneider
- Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Physical Medicine & Rehabilitation, Spaulding Research Institute, Harvard Medical School, Boston, Massachusetts, USA
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Dalton MK, Riviello R, Kubasiak JC, Sokas CM, Osman SY, Jin G, Nitzschke SL, Ortega G. The impact of the Affordable Care Act's medicaid expansion on patients admitted for burns: An analysis of national data. Burns 2021; 48:1340-1346. [PMID: 34903411 DOI: 10.1016/j.burns.2021.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 10/24/2021] [Accepted: 10/29/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The first states began implementing the Medicaid expansion provisions of the Patient Protection and Affordable Care Act (ACA) in 2014. Studies have yet to address its impact on burn patients. METHODS Burn patients in geographic regions that expanded Medicaid coverage were compared to patients in regions that did not expand Medicaid before and after implementation of the ACA using bivariate statistics and a difference-in-differences model. A multivariable logistic regression was used to identify factors associated with having Medicaid insurance. The primary outcome of this study was the rate of Medicaid insurance. RESULTS Of 25,331 discharges, we found greater increases in Medicaid coverage after the ACA in the Medicaid expander regions (23.4-40.2%) compared to the non-expander regions (18.5-20.1%). The difference-in-differences estimate between the expander and non-expander regions was 0.15 (95% CI: 0.11-0.18, p < 0.001). Patients admitted in expander regions were more likely to be insured by Medicaid (OR 1.57 [95%CI 1.21-2.05]), as were patients of Black race (OR 1.25 [95%CI 1.19-1.32), Hispanic ethnicity (OR 1.29 [95%CI 1.14-1.46]), and female sex (OR 1.59 [95%CI 1.11-2.27]). We also found a significant interaction between time period (pre-ACA/post-ACA) and expander region location (OR 2.10 [95%CI 1.67-2.62]). CONCLUSIONS The Medicaid expansion provision of the ACA led to increased Medicaid coverage among burn patients which was significantly higher in areas with widespread implementation of the expansion.
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Affiliation(s)
- Michael K Dalton
- Center for Surgery and Public Health, Harvard Medical School, Harvard T. H. Chan School of Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA; Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA.
| | - Robert Riviello
- Division of Trauma, Burns, and Surgical Critical Care, Brigham and Women's Hospital, Boston, MA, USA
| | - John C Kubasiak
- Division of Trauma, Burns, and Surgical Critical Care, Brigham and Women's Hospital, Boston, MA, USA
| | - Claire M Sokas
- Center for Surgery and Public Health, Harvard Medical School, Harvard T. H. Chan School of Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA; Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Samia Y Osman
- Center for Surgery and Public Health, Harvard Medical School, Harvard T. H. Chan School of Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Ginger Jin
- Center for Surgery and Public Health, Harvard Medical School, Harvard T. H. Chan School of Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Gezzer Ortega
- Center for Surgery and Public Health, Harvard Medical School, Harvard T. H. Chan School of Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA.
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10
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Sheckter CC, Brych S, Carrougher GJ, Wolf SE, Schneider JC, Gibran N, Stewart BT. Exploring 'Return to Productivity' Among People Living with Burn Injury: a Burn Model System National Database Report. J Burn Care Res 2021; 42:1081-1086. [PMID: 34302467 DOI: 10.1093/jbcr/irab139] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Burn survivors experience barriers to returning to work. For those who do return to work, little is known regarding whether they achieve pre-injury productivity (i.e., equivalent or gain in income compared to pre-injury income). Identifying patients at risk of not achieving pre-injury productivity is important for targeting services that support this population. METHODS We extracted occupational and income data through 24 months post-injury from the multi-center, longitudinal Burn Model System National Database. Annual income was reported in six groups: <$25k, $25k-50k, $50k-99k, $100k-149k, $150k-199k, $>199k. Participants were classified by change in income at each follow up (i.e., gain, loss, equivalent). Explanatory variables included demographics, injury characteristics, insurance payer, employment status, and job type. Multi-level, multi-variable logistic regression was used to model return to productivity. RESULTS 453 participants provided complete income data at discharge and follow up. Of the 302 participants employed pre-injury, 180 (60%) returned to work within 24 months post-injury. Less than half (138) returned to productivity (46% of participants employed pre-injury; 77% of those who returned to work). Characteristics associated with return to productivity included older age (median 46.9 vs 45.9 years, OR 1.03, p=0.006), Hispanic ethnicity (24% vs 11%, OR 1.80, p=0.041), burn size >20% TBSA (33.7% vs 33.0%, OR 2.09, p=0.045), and post-injury employment (54% vs 26%, OR 3.41, p<0.001). CONCLUSION More than half of employed people living with burn injury experienced loss in productivity within 24 months post-injury. Even if they return to work, people living with burn injuries face challenges returning to productivity and may benefit from vocational rehabilitation and/or financial assistance.
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Affiliation(s)
- Clifford C Sheckter
- UW Medicine Regional Burn Center, Harborview Medical Center, University of Washington
| | - Sabina Brych
- UW Medicine Regional Burn Center, Harborview Medical Center, University of Washington
| | - Gretchen J Carrougher
- UW Medicine Regional Burn Center, Harborview Medical Center, University of Washington
| | - Steven E Wolf
- Shriners Burns Hospital, University of Texas Medical Branch
| | - Jeffrey C Schneider
- Spaulding Rehabilitation Hospital, Spaulding Research Institute, Department of Physical Medicine and Rehabilitation, Harvard Medical School
| | - Nicole Gibran
- UW Medicine Regional Burn Center, Harborview Medical Center, University of Washington
| | - Barclay T Stewart
- UW Medicine Regional Burn Center, Harborview Medical Center, University of Washington.,Harborivew Injury Prevention and Research Center
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11
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Carrougher GJ, McMullen K, Amtmann D, Wolfe AE, Tenney D, Schneider JC, Yeakley J, Holavanahalli RK, Patterson L, Madison C, Gibran NS. "Living Well" After Burn Injury: Using Case Reports to Illustrate Significant Contributions From the Burn Model System Research Program. J Burn Care Res 2021; 42:398-407. [PMID: 32971531 PMCID: PMC10044562 DOI: 10.1093/jbcr/iraa161] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
The Burn Model System (BMS) program of research has been funded since 1993 by the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR). The overarching aim of this program is to improve outcomes and quality of life for people with burns in the areas of health and function, employment, and community living and participation. This review reports on BMS contributions that have affected the lives of individuals with a significant burn injury using case reports to associate BMS contributions with recovery. In January 2020, current BMS grantee researchers assessed peer-reviewed BMS publications from 1994 to 2020. Using case report methodology, contributions were linked to three individuals treated at one of the four Burn Model System institutions. With over 25 years of NIDILRR funding, unique BMS contributions to patient recovery were identified and categorized into one of several domains: treatment, assessment measures, sequelae, peer support, employment, and long-term functional outcomes. A second review for significant results of BMS research that add to the understanding of burn injury, pathophysiology, and recovery research was identified and categorized as injury recovery research. The case study participants featured in this review identified select NIDILRR research contributions as having direct, personal benefit to their recovery. The knowledge generation and clinical innovation that this research program has contributed to our collective understanding of recovery after burn injury is considerable. Using case study methodology with three adult burn survivors, we highlight the impact and individual significance of program findings and reinforce the recognition that the value of any clinical research must have relevance to the lives of the study population.
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Affiliation(s)
| | - Kara McMullen
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington
| | - Dagmar Amtmann
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington
| | - Audrey E Wolfe
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Jeffrey C Schneider
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts
| | | | | | - Loren Patterson
- University of Texas Southwestern Medical Center, Dallas, Texas
| | | | - Nicole S Gibran
- Department of Surgery, University of Washington, Seattle, Washington
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12
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Stockly OR, Wolfe AE, Carrougher GJ, Stewart BT, Gibran NS, Wolf SE, McMullen K, Bamer AM, Kowalske K, Cioffi WG, Zafonte R, Schneider JC, Ryan CM. Inhalation injury is associated with long-term employment outcomes in the burn population: Findings from a cross-sectional examination of the Burn Model System National Database. PLoS One 2020; 15:e0239556. [PMID: 32966317 PMCID: PMC7511001 DOI: 10.1371/journal.pone.0239556] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 09/08/2020] [Indexed: 12/23/2022] Open
Abstract
Introduction Inhalation injuries carry significant acute care burden including prolonged ventilator days and length of stay. However, few studies have examined post-acute outcomes of inhalation injury survivors. This study compares the long-term outcomes of burn survivors with and without inhalation injury. Methods Data collected by the Burn Model System National Database from 1993 to 2019 were analyzed. Demographic and clinical characteristics for adult burn survivors with and without inhalation injury were examined. Outcomes included employment status, Short Form-12/Veterans Rand-12 Physical Composite Score (SF-12/VR-12 PCS), Short Form-12/Veterans Rand-12 Mental Composite Score (SF-12/VR-12 MCS), and Satisfaction With Life Scale (SWLS) at 24 months post-injury. Regression models were used to assess the impacts of sociodemographic and clinical covariates on long-term outcome measures. All models controlled for demographic and clinical characteristics. Results Data from 1,871 individuals were analyzed (208 with inhalation injury; 1,663 without inhalation injury). The inhalation injury population had a median age of 40.1 years, 68.8% were male, and 69% were White, non-Hispanic. Individuals that sustained an inhalation injury had larger burn size, more operations, and longer lengths of hospital stay (p<0.001). Individuals with inhalation injury were less likely to be employed at 24 months post-injury compared to survivors without inhalation injury (OR = 0.63, p = 0.028). There were no significant differences in PCS, MCS, or SWLS scores between groups in adjusted regression analyses. Conclusions Burn survivors with inhalation injury were significantly less likely to be employed at 24 months post-injury compared to survivors without inhalation injury. However, other health-related quality of life outcomes were similar between groups. This study suggests distinct long-term outcomes in adult burn survivors with inhalation injury which may inform future resource allocation and treatment paradigms.
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Affiliation(s)
- Olivia R. Stockly
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA, United States of America
| | - Audrey E. Wolfe
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA, United States of America
| | | | - Barclay T. Stewart
- Department of Surgery, University of Washington, Seattle, WA, United States of America
- Harborview Injury Prevention and Research Center, Seattle, WA, United States of America
| | - Nicole S. Gibran
- Department of Surgery, University of Washington, Seattle, WA, United States of America
| | - Steven E. Wolf
- Department of Surgery, University of Texas Medical Branch, Galveston, TX, United States of America
| | - Kara McMullen
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, United States of America
| | - Alyssa M. Bamer
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, United States of America
| | - Karen Kowalske
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, TX, United States of America
| | - William G. Cioffi
- Department of Surgery, Brown University, Rhode Island Hospital, Providence, RI, United States of America
| | - Ross Zafonte
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA, United States of America
| | - Jeffrey C. Schneider
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA, United States of America
- * E-mail:
| | - Colleen M. Ryan
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
- Shriners Hospitals for Children—Boston, Boston, MA, United States of America
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13
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Pham TN, Goldstein R, Carrougher GJ, Gibran NS, Goverman J, Esselman PC, Kazis LE, Ryan CM, Schneider JC. The impact of discharge contracture on return to work after burn injury: A Burn Model System investigation. Burns 2020; 46:539-545. [PMID: 32088093 DOI: 10.1016/j.burns.2020.02.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 01/22/2020] [Accepted: 02/06/2020] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Despite many advances in burn care, the development of extremity contracture remains a common and vexing problem. Extremity contractures have been documented in up to one third of severely burned patients at discharge. However, little is known about the long-term impact of these contractures. The purpose of this study was to examine the association of extremity contractures with employment after burn injury. METHODS We obtained data from the Burn Model System database from 1994 to 2003. We included in the study cohort all adult patients who were working prior to injury and identified those discharged with and without a contracture in one of the major extremity joints (shoulder, elbow, wrist, hip, knee and ankle). We classified contracture severity according to mild, moderate and severe categories. We performed descriptive analyses and predictive modeling to identify injury and patient factors associated with return to work (RTW) at 6, 12, and 24 months. RESULTS A total of 1,203 participant records met criteria for study inclusion. Of these, 415 (35%) had developed a contracture at discharge; 9% mild, 12% moderate, and 14% severe. Among 801 (67%) participants who had complete data at 6 months after discharge, 70% of patients without contracture had returned to work compared to 45% of patients with contractures (p < 0.001). RTW increased at each subsequent follow-up time point for the contracture group, however, it remained significantly lower than in no-contracture group (both p < 0.01). In multivariable analyses, female sex, non-Caucasian ethnicity, larger burn size, alcohol abuse, number of in-hospital operations, amputation, and in-hospital complications were associated with a lower likelihood of employment. In adjusted analyses, discharge contracture was associated with a lower probability of RTW at all 3 time points, although its impact significantly diminished at 24 months. CONCLUSIONS This study indicates an association between discharge contracture and reduced employment 6, 12 and 24 months after burn injury. Among many other identified patient, injury, and hospitalization related factors that are barriers to RTW, the presence of a contracture at discharge adds a significant reintegration burden for working-age burn patients.
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Affiliation(s)
- Tam N Pham
- UW Medicine Regional Burn Center, Department of Surgery, University of Washington, United States.
| | - Richard Goldstein
- Spaulding Rehabilitation Hospital, Department of Physical Medicine and Rehabilitation, Harvard Medical School, United States
| | - Gretchen J Carrougher
- UW Medicine Regional Burn Center, Department of Surgery, University of Washington, United States
| | - Nicole S Gibran
- UW Medicine Regional Burn Center, Department of Surgery, University of Washington, United States
| | - Jeremy Goverman
- Shriners Hospitals for Children-Boston, Department of Surgery, Harvard Medical School, United States
| | - Peter C Esselman
- Department of Rehabilitation Medicine, University of Washington, United States
| | - Lewis E Kazis
- Department of Health Law and Policy and Management, Boston University School of Public Health, United States
| | - Colleen M Ryan
- Shriners Hospitals for Children-Boston, Department of Surgery, Harvard Medical School, United States
| | - Jeffrey C Schneider
- Spaulding Rehabilitation Hospital, Department of Physical Medicine and Rehabilitation, Harvard Medical School, United States
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