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Sheckter CC, Holan C, Carrougher G, Orton C, Gibran N, Stewart BT. Higher Out-of-pocket Expenses are Associated with Worse Health-related Quality of Life in Burn Survivors: A Northwest Regional Burn Model System Investigation. J Burn Care Res 2023; 44:1349-1354. [PMID: 37094279 DOI: 10.1093/jbcr/irad058] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Indexed: 04/26/2023]
Abstract
The care required to recover serious burn injuries is costly. In the United States, these costs are often borne by patients. Examining the relationship between out-of-pocket (OOP) costs and health-related quality of life (HRQL) is important to support burn survivors. Financial data from a regional burn center were merged with data in the Burn Model System (BMS) National Database. HRQL outcomes included VA-Rand 12 (VR-12) physical component summary (PCS) and mental component summary (MCS) scores. Participant surveys were conducted at 6-, 12-, and 24-months post-injury. VR-12 scores were evaluated using generalized linear models and adjusted for potential confounders (age, sex, insurance/payer, self-identified race/ethnicity, measures of burn injury severity). 644 participants were included, of which 13% (84) had OOP costs. The percentage of participants with OOP costs was 34% for commercial/private, 22% for Medicare, 8% for other, 4% for self-pay, and 0% for workers' compensation and Medicaid. For participants with OOP expenses, median payments were $875 with an IQR of $368-1728. In addition to markers of burn injury severity, OOP costs were negatively associated with PCS scores at 6-months (coefficient -0.002, P < .001) and 12-months post-injury (coefficient -0.001, P = .004). There were no significant associations with PCS scores at 24 months post-injury or MCS scores at any interval. Participants with commercial/private or Medicare payer had higher financial liability than other payers. Higher OOP expenses were negatively associated with physical HRQL for at least 12 months after injury. Financial toxicity occurs after burn injury and providers should target resources accordingly.
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Affiliation(s)
- Clifford C Sheckter
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Stanford University, USA
- Regional Burn Center at Santa Clara Valley Medical Center, Department of Surgery, USA
| | - Cole Holan
- Dell Medical School, The University of Texas, Austin, USA
| | - Gretchen Carrougher
- UW Medicine Regional Burn Center, Harborview Medical Center, University of Washington, USA
| | - Caitlin Orton
- UW Medicine Regional Burn Center, Harborview Medical Center, University of Washington, USA
| | - Nicole Gibran
- UW Medicine Regional Burn Center, Harborview Medical Center, University of Washington, USA
| | - Barclay T Stewart
- UW Medicine Regional Burn Center, Harborview Medical Center, University of Washington, USA
- Harborview Injury Prevention and Research Center, University of Washington, USA
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Martz F, McMullen KA, Carrougher GJ, Bunnell A, Sheckter CC, Wolf SE, Schneider JC, Stewart BT. Impacts of Financial Assistance on Quality of Life Among People Living With Burn Injury: Matched Cohort Analysis of the National Institute on Disability, Independent Living and Rehabilitation Research Burn Model System Database. J Burn Care Res 2023; 44:363-372. [PMID: 35699664 DOI: 10.1093/jbcr/irac079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Indexed: 11/14/2022]
Abstract
Disparities in socioeconomic status and minority status affect the risk of burn injury and the severity of that injury, thus affecting the subsequent cost of care. We aimed to characterize the demographic details surrounding receipt of financial assistance due to burn injury and its relationship with health-related quality of life scores. Participants ≥18 from Burn Model System National Longitudinal Database (BMS) with complete demographic data were included (n = 4330). Nonresponders to financial assistance questions were analyzed separately. The remaining sample (n = 1255) was divided into participants who received financial assistance because of burn injury, those who received no financial assistance, and those who received financial assistance before injury and as a result of injury. A demographic and injury-characteristic comparison was conducted. Health-related quality of life metrics (Satisfaction with Life, Short Form-12/Veterans RAND 12-Item Health Survey, Community Integration Questionnaire Social Component, and the Post-Traumatic Growth Inventory) were analyzed preinjury, then 6-months, 1-year, and 2-years postinjury. A matched cohort analysis compared these scores. When compared to their no financial assistance counterparts, participants receiving financial assistance due to burns were more likely to be minorities (19% vs 14%), have more severe injuries (%TBSA burn 21% vs 10%), and receive workers' compensation (24% vs 9%). They also had lower health-related quality of life scores on all metrics except the post-traumatic growth inventory. Financial assistance may aid in combating disparities in posttraumatic growth scores for participants at the greatest risk of financial toxicity but does not improve other health-related quality of life metrics.
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Affiliation(s)
- Flora Martz
- Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA
| | - Kara A McMullen
- UW Medicine Regional Burn Center, Harborview Medical Center, University of Washington, Seattle, USA.,Department of Rehabilitation Medicine, University of Washington, Seattle, USA
| | - Gretchen J Carrougher
- UW Medicine Regional Burn Center, Harborview Medical Center, University of Washington, Seattle, USA
| | - Aaron Bunnell
- UW Medicine Regional Burn Center, Harborview Medical Center, University of Washington, Seattle, USA
| | | | - Steven E Wolf
- Department of Surgery, The University of Texas Medical Branch, Galveston, USA.,Shriners Children's, Texas, Galveston, USA
| | - Jeffrey C Schneider
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Barclay T Stewart
- UW Medicine Regional Burn Center, Harborview Medical Center, University of Washington, Seattle, USA.,Harborview Injury Prevention and Research Center, Seattle, Washington, USA
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