TY - JOUR
T1 - Variability in discharge disposition across US trauma centers after treatment for high-energy lower extremity injuries
AU - on behalf of METRC
AU - Gitajn, Ida L.
AU - Reider, Lisa
AU - Scharfstein, Daniel O.
AU - O’Toole, Robert V.
AU - Bosse, Michael J.
AU - Castillo, Renan C.
AU - Jevsevar, David S.
AU - Pollak, Andrew N.
N1 - Funding Information:
Supported by the Office of Assistant Secretary of Defense for Health Affairs Congressionally Directed Medical Research Programs, through the Peer Reviewed Orthopaedic Research Program, contract numbers W81XWH-09-2-0108, W81XWH-10-2-0090, W81XWH-10-2-0134, and W81XWH-12-1-0588. Opinions, interpretations, conclusions, and rec-ommendations are those of the authors and are not necessarily endorsed by the Department of Defense.
Publisher Copyright:
Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2020
Y1 - 2020
N2 - Objective: To evaluate the association between patient- and center-level characteristics and discharge to an inpatient facility versus home after treatment for lower extremity trauma, as well as examine the variability in discharge disposition across clinical centers after controlling for these factors. Design: This is an analysis of data collected prospectively across 5 multicenter studies of extremity trauma. Setting: US Trauma Centers. Participants: Patients 18–80 years with lower extremity trauma treated at 1 of 55 participating centers. Main Outcome Measure: Discharge disposition. Results: Among 2365 patients treated at 1 of 55 centers across 13 states, 673 (28.5%) were discharged to an inpatient facility, and 1692 (71.5%) were discharged home. Individuals who were older, female, unmarried, insured, higher body mass index, history of severe alcohol abuse, Gustilo type IIIB or IIIC open injuries, bilateral, spine and upper extremity injuries, higher injury severity score scores, or intensive care unit stay were more likely to be discharged to an inpatient facility. Even after accounting for patient- and center-level characteristics, there was substantial variation in discharge disposition across centers (likelihood ratio test: P, 0.001). Conclusion: Variation in discharge disposition may represent a potential for improvement in resource utilization and cost savings. Further studies are needed to examine the relationship between utilization of postdischarge inpatient facility after trauma and outcomes.
AB - Objective: To evaluate the association between patient- and center-level characteristics and discharge to an inpatient facility versus home after treatment for lower extremity trauma, as well as examine the variability in discharge disposition across clinical centers after controlling for these factors. Design: This is an analysis of data collected prospectively across 5 multicenter studies of extremity trauma. Setting: US Trauma Centers. Participants: Patients 18–80 years with lower extremity trauma treated at 1 of 55 participating centers. Main Outcome Measure: Discharge disposition. Results: Among 2365 patients treated at 1 of 55 centers across 13 states, 673 (28.5%) were discharged to an inpatient facility, and 1692 (71.5%) were discharged home. Individuals who were older, female, unmarried, insured, higher body mass index, history of severe alcohol abuse, Gustilo type IIIB or IIIC open injuries, bilateral, spine and upper extremity injuries, higher injury severity score scores, or intensive care unit stay were more likely to be discharged to an inpatient facility. Even after accounting for patient- and center-level characteristics, there was substantial variation in discharge disposition across centers (likelihood ratio test: P, 0.001). Conclusion: Variation in discharge disposition may represent a potential for improvement in resource utilization and cost savings. Further studies are needed to examine the relationship between utilization of postdischarge inpatient facility after trauma and outcomes.
KW - Discharge disposition
KW - High-energy trauma
KW - Rehabilitation
KW - Resource utilization
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U2 - 10.1097/BOT.0000000000001657
DO - 10.1097/BOT.0000000000001657
M3 - Article
C2 - 31868766
AN - SCOPUS:85080850753
VL - 34
SP - E78-E85
JO - Journal of Orthopaedic Trauma
JF - Journal of Orthopaedic Trauma
SN - 0890-5339
IS - 3
ER -