DeMario Belinda, Kalina Mark J, Truong Evelyn, Hendrickson Sarah, Tseng Esther S, Claridge Jeffrey A, Vallier Heather, Ho Vanessa P
From the Division of Trauma, Critical Care, Burn, and Acute Care Surgery, Department of Surgery (B.D., E.T., E.S.T., J.A.C., V.P.H.), Community Trauma Institute (B.D., M.J.K., S.H., H.V.), and Department of Orthopedic Surgery (H.V.), MetroHealth Medical Center; and Department of Population and Quantitative Health Sciences (V.P.H.), Case Western Reserve University School of Medicine, Cleveland, Ohio.
J Trauma Acute Care Surg. 2020 Dec;89(6):1177-1182. doi: 10.1097/TA.0000000000002872.
Trauma patients are often noted to have poor compliance but high recidivism and readmission rates. Participation in a trauma recovery services (TRS) program, which provides peer support and other psychosocial resources, may impact the trajectory of patient recovery by decreasing barriers to follow-up. We hypothesized that TRS participants would have greater downstream nonemergent use of our hospital system over the year following trauma, manifested by more positive encounters, fewer negative encounters, and lower emergency department (ED) charges.
We studied trauma survivors (March 2017 to March 2018) offered TRS. Hospital encounters and charges 1 year from index admission were compared between patients who accepted and declined TRS. Positive encounters were defined as outpatient visits and planned admissions; negative encounters were defined as no shows, ED visits, and unplanned admissions. Charges were grouped as cumulative ED and non-ED charges (including outpatient and subsequent admission charges). Adjusted logistic and linear regression analyses were used to identify factors associated with positive/negative encounters and ED charges.
Of 511 identified patients (68% male; injury severity score, 14 [9-19]), 362 (71%) accepted TRS. Trauma recovery services patients were older, had higher injury severity, and longer index admission length of stay (all p < 0.05). After adjusting for confounders, TRS patients were more likely to have at least one positive encounter and were similarly likely to have negative encounters as patients who declined services. Total aggregate charges for this group was US $74 million, of which US $30 million occurred downstream of the index admission. Accepting TRS was associated with lower ED charges.
A comprehensive TRS program including education, peer mentors, and a support network may provide value to the patient and the health care system by reducing subsequent care provided by the ED in the year after a trauma without affecting nonemergent care.
Therapeutic/care management, level IV.
创伤患者常常被指出依从性差，但复发率和再入院率高。参与创伤康复服务（TRS）项目，该项目提供同伴支持和其他心理社会资源，可能通过减少随访障碍来影响患者的康复轨迹。我们假设TRS参与者在创伤后的一年中对我们医院系统的下游非紧急使用会更多，表现为更多的积极就诊、更少的消极就诊以及更低的急诊科（ED）费用。
我们研究了2017年3月至2018年3月期间提供TRS的创伤幸存者。比较了接受和拒绝TRS的患者自首次入院起1年的医院就诊情况和费用。积极就诊定义为门诊就诊和计划内入院；消极就诊定义为爽约、急诊就诊和非计划内入院。费用分为累积的急诊和非急诊费用（包括门诊和后续入院费用）。采用调整后的逻辑回归和线性回归分析来确定与积极/消极就诊及急诊费用相关的因素。
在511名确定的患者中（68%为男性；损伤严重程度评分，14[9 - 19]），362名（71%）接受了TRS。创伤康复服务患者年龄更大，损伤更严重，首次入院住院时间更长（均p < 0.05）。在调整混杂因素后，TRS患者更有可能至少有一次积极就诊，并且与拒绝服务的患者出现消极就诊的可能性相似。该组的总费用为7400万美元，其中3000万美元发生在首次入院之后。接受TRS与更低的急诊费用相关。
一个包括教育、同伴导师和支持网络的综合性TRS项目可能通过减少创伤后一年中急诊科提供的后续护理而不影响非紧急护理，为患者和医疗保健系统带来价值。
治疗/护理管理，IV级。
