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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
Greene, Nathaniel H
Pham, Tam N
Esselman, Peter C
Rivara, Frederick P
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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
https://hdl.handle.net/10161/9370
Published Version (Please cite this version)
10.1097/BCR.0000000000000200
Publication Info
Greene, Nathaniel H; Pham, Tam N; Esselman, Peter C; & Rivara, Frederick P (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 https://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
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