Variation in Inpatient Rehabilitation Utilization After Hospitalization for Burn Injury in the United States.
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 articleSubject
AgedBurn 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
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http://hdl.handle.net/10161/9370Published Version (Please cite this version)
10.1097/BCR.0000000000000200Publication 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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Nathaniel Howard Greene
Assistant Professor of Anesthesiology

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