Journal
JOURNAL OF TRAUMA AND ACUTE CARE SURGERY
Volume 89, Issue 6, Pages 1177-1182Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/TA.0000000000002872
Keywords
Trauma outcomes; peer mentoring; trauma recovery
Categories
Funding
- Clinical and Translational Science Collaborative of Cleveland [KL2TR002547]
- Victims of Crime Act grant from the Ohio Office of the Attorney General
- National Center for Advancing Translational Sciences (NCATS) component of the National Institutes of Health (NIH) [KL2TR002547]
- NIH roadmap for Medical Research
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BACKGROUND 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. METHODS 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. RESULTS 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. CONCLUSION 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.
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