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    Variation in Inpatient Rehabilitation Utilization After Hospitalization for Burn Injury in the United States.

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    Date
    2015-11
    Authors
    Esselman, PC
    Greene, Nathaniel Howard
    Pham, TN
    Rivara, FP
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    Abstract
    Approximately 45,000 individuals are hospitalized annually for burn treatment. Rehabilitation after hospitalization can offer a significant improvement in functional outcomes. Very little is known nationally about rehabilitation for burns, and practices may vary substantially depending on the region based on observed Medicare post-hospitalization spending amounts. This study was designed to measure variation in rehabilitation utilization by state of hospitalization for patients hospitalized with burn injury. This retrospective cohort study used nationally collected data over a 10-year period (2001 to 2010), from the Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases (SIDs). Patients hospitalized for burn injury (n = 57,968) were identified by ICD-9-CM codes and were examined to see specifically if they were discharged immediately to inpatient rehabilitation after hospitalization (primary endpoint). Both unadjusted and adjusted likelihoods were calculated for each state taking into account the effects of age, insurance status, hospitalization at a burn center, and extent of burn injury by TBSA. The relative risk of discharge to inpatient rehabilitation varied by as much as 6-fold among different states. Higher TBSA, having health insurance, higher age, and burn center hospitalization all increased the likelihood of discharge to inpatient rehabilitation following acute care hospitalization. There was significant variation between states in inpatient rehabilitation utilization after adjusting for variables known to affect each outcome. Future efforts should be focused on identifying the cause of this state-to-state variation, its relationship to patient outcome, and standardizing treatment across the United States.
    Type
    Journal article
    Subject
    Aged
    Burn Units
    Burns
    Cohort Studies
    Databases, Factual
    Female
    Follow-Up Studies
    Health Care Costs
    Hospitalization
    Humans
    Injury Severity Score
    Inpatients
    Length of Stay
    Logistic Models
    Male
    Medicare
    Middle Aged
    Multivariate Analysis
    Poisson Distribution
    Rehabilitation Centers
    Retrospective Studies
    Risk Assessment
    Treatment Outcome
    United States
    Permalink
    http://hdl.handle.net/10161/9370
    Published Version (Please cite this version)
    10.1097/BCR.0000000000000200
    Publication Info
    Esselman, PC; Greene, Nathaniel Howard; Pham, TN; & Rivara, FP (2015). Variation in Inpatient Rehabilitation Utilization After Hospitalization for Burn Injury in the United States. J Burn Care Res, 36(6). pp. 613-618. 10.1097/BCR.0000000000000200. Retrieved from http://hdl.handle.net/10161/9370.
    This is constructed from limited available data and may be imprecise. To cite this article, please review & use the official citation provided by the journal.
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    Scholars@Duke

    Greene

    Nathaniel Howard Greene

    Assistant Professor of Anesthesiology
    Open Access

    Articles written by Duke faculty are made available through the campus open access policy. For more information see: Duke Open Access Policy

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