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Tenorio A, Brandel MG, McCann CP, Real M, Doucet JJ, Costantini TW, Santiago-Dieppa DR, Levy M, Ciacci JD. Increased Traumatic Brain Injury Severity and Mortality in Undocumented Immigrants. Neurosurgery 2024:00006123-990000000-01327. [PMID: 39212417 DOI: 10.1227/neu.0000000000003158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 07/23/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Health disparities related to traumatic brain injury (TBI) have focused on socioeconomic status, race, and ethnicity. We sought to characterize TBI patterns and outcomes based on undocumented status. METHODS Patients who presented to University of California, San Diego Health Trauma Center with a TBI between 2019 and 2022 were identified and stratified based on undocumented status. Undocumented immigrants were identified using validated methods of absent or invalid social security number and key terms through chart review. Demographic information, injury characteristics, and neurosurgical interventions were recorded. Univariable and multivariable analyses were performed to determine the impact of patient factors on outcomes. RESULTS Of 1654 patients with TBI, 76 (4.6%) were undocumented. Undocumented immigrants were younger (50 vs 60 years; P < .001) and had higher Injury Severity Score (17 vs 13; P < .001). They presented from farther distances (12.8 vs 5.3 miles, P < .001) with greater midline shift (1.49 vs 0.91 mm; P = .003). A greater proportion had basal cistern compression/effacement (14% vs 4.6%; P = .001) and required neurosurgical intervention (18% vs 9.6%; P = .012). Undocumented immigrants had higher hospital charges ($208 403 vs $128 948; P < .001), length of stay (5 vs 4 days; P = .002), and were discharged to a health facility at a lower rate (18% vs 32%; P = .012). They had nearly double the mortality rate (14% vs 7.3%; P = .021), with undocumented status trending as a predictor on multivariable regression (odds ratio = 2.87; P = .052). CONCLUSION Undocumented immigrants presented from farther distances with increased TBI severity, likely from both more severe trauma and delayed presentation, requiring more neurosurgical intervention. They also had greater length of stay, charges, and nearly double the mortality rate. Importantly, undocumented status was a strong predictor for mortality. Despite worse outcomes, they were discharged to a health care facility at a lower rate. Advocacy efforts should be directed at increasing health care coverage and migrant community engagement and education.
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Affiliation(s)
- Alexander Tenorio
- Department of Neurosurgery, University of California, San Diego, La Jolla, California, USA
| | - Michael G Brandel
- Department of Neurosurgery, University of California, San Diego, La Jolla, California, USA
| | - Carson P McCann
- School of Medicine, University of California, San Diego, La Jolla, California, USA
| | - Marcos Real
- School of Medicine, University of California, San Diego, La Jolla, California, USA
| | - Jay J Doucet
- Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, Department of Surgery, University of California, San Diego, La Jolla, California, USA
| | - Todd W Costantini
- Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, Department of Surgery, University of California, San Diego, La Jolla, California, USA
| | | | - Michael Levy
- Department of Neurosurgery, University of California, San Diego, La Jolla, California, USA
| | - Joseph D Ciacci
- Department of Neurosurgery, University of California, San Diego, La Jolla, California, USA
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Ono Y, Ishida T, Tomita N, Takayama K, Kakamu T, Kotani J, Shinohara K. Attempted Suicide Is Independently Associated with Increased In-Hospital Mortality and Hospital Length of Stay among Injured Patients at Community Tertiary Hospital in Japan: A Retrospective Study with Propensity Score Matching Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:121. [PMID: 38397612 PMCID: PMC10888049 DOI: 10.3390/ijerph21020121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 01/20/2024] [Accepted: 01/22/2024] [Indexed: 02/25/2024]
Abstract
Suicide is an increasingly important public healthcare concern worldwide. Studies examining the effect of attempted suicide on clinical outcomes among patients with trauma are scarce. We conducted a retrospective cohort study at a community emergency department in Japan. We included all severely injured patients with an Injury Severity Score > 15 from January 2002 to December 2021. The primary outcome measure was in-hospital mortality. The other outcome of interest was hospital length of stay. One-to-one propensity score matching was performed to compare these outcomes between suicide attempt and no suicide attempt groups. Of the 2714 eligible patients, 183 (6.7%) had trauma caused by a suicide attempt. In the propensity score-matched analysis with 139 pairs, the suicide attempt group showed a significant increase in-hospital mortality (20.9% vs. 37.4%; odds ratio 2.27; 95% confidence intervals 1.33-3.87) compared with the no suicide attempt group. Among survivors, the median hospital length of stay was significantly longer in the suicide attempt group than that in the no suicide attempt group (9 days vs. 12 days, p = 0.0076). Because of the unfavorable consequences and potential need for additional healthcare, increased attention should be paid to patients with trauma caused by a suicide attempt.
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Affiliation(s)
- Yuko Ono
- Department of Disaster and Emergency Medicine, Graduate School of Medicine, Kobe University, Kobe City 650-0017, Japan; (K.T.); (J.K.)
- Department of Anesthesiology, Ohta General Hospital Foundation, Ohta Nishinouchi Hospital, Koriyama City 963-8558, Japan; (T.I.); (N.T.); (K.S.)
| | - Tokiya Ishida
- Department of Anesthesiology, Ohta General Hospital Foundation, Ohta Nishinouchi Hospital, Koriyama City 963-8558, Japan; (T.I.); (N.T.); (K.S.)
| | - Nozomi Tomita
- Department of Anesthesiology, Ohta General Hospital Foundation, Ohta Nishinouchi Hospital, Koriyama City 963-8558, Japan; (T.I.); (N.T.); (K.S.)
| | - Kazushi Takayama
- Department of Disaster and Emergency Medicine, Graduate School of Medicine, Kobe University, Kobe City 650-0017, Japan; (K.T.); (J.K.)
| | - Takeyasu Kakamu
- Department of Hygiene and Preventive Medicine, School of Medicine, Fukushima Medical University, Fukushima City 960-1295, Japan;
| | - Joji Kotani
- Department of Disaster and Emergency Medicine, Graduate School of Medicine, Kobe University, Kobe City 650-0017, Japan; (K.T.); (J.K.)
| | - Kazuaki Shinohara
- Department of Anesthesiology, Ohta General Hospital Foundation, Ohta Nishinouchi Hospital, Koriyama City 963-8558, Japan; (T.I.); (N.T.); (K.S.)
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Gebran A, El Moheb M, Herrera-Escobar JP, Proaño-Zamudio JA, Maurer LR, Lamarre TE, Bou Zein Eddine S, Sanchez SE, Nehra D, Salim A, Velmahos GC, Kaafarani HMA. Insurance Not Socioeconomic Status is Associated With Access to Postacute Care After Injury: A Multicenter Cohort Study. J Surg Res 2024; 293:307-315. [PMID: 37806216 DOI: 10.1016/j.jss.2023.08.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 07/19/2023] [Accepted: 08/25/2023] [Indexed: 10/10/2023]
Abstract
INTRODUCTION Access to postacute care services in rehabilitation or skilled nursing facilities is essential to return trauma patients to their preinjury functional level but is often hindered by systemic barriers. We sought to study the association between the type of insurance, socioeconomic status (SES) measures, and postacute care utilization after injury. METHODS Adult trauma patients with an Injury Severity Score (ISS) ≥9 admitted to one of three Level I trauma centers were contacted 6-12 mo after injury to gather long-term functional and patient-centered outcome measures. In addition to SES inquiry specifically focused on education and income levels, patients were asked to subjectively categorize their perceived SES (p-SES) as high, mid-high, mid-low, or low. Insurance and income data were retrieved from trauma registries. Multivariable regression models were built to determine the association between type of insurance, SES, and discharge disposition after adjusting for patient and injury characteristics and hospitalization events. RESULTS A total of 1373 patients were included, of which 44% were discharged to postacute care facilities. The median age (IQR) was 65 (46, 76) years, 56% of patients were male, 11% were on Medicaid, 68% had attained education higher than high school, 27% had low income, and 29% reported a low/mid-low p-SES. Medicaid patients were less likely to be discharged to postacute care compared to privately insured (OR [95% CI]: 0.41 [0.29-0.58]) and Medicare patients (OR [95% CI]: 0.29 [0.16-0.50]). The latter relationship was true across p-SES categories. P-SES, income and educational level were not associated with discharge destination. CONCLUSIONS Insurance status, specifically having Medicaid, can pose a barrier to access to postacute care services in the trauma patient population across patients of all SES. Initiatives and policies that aim at reducing these access disparities are warranted.
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Affiliation(s)
- Anthony Gebran
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital, Boston, Massachusetts
| | - Mohamad El Moheb
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital, Boston, Massachusetts
| | - Juan P Herrera-Escobar
- Division of Trauma, Burn and Surgical Critical Care, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School and Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Jefferson A Proaño-Zamudio
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital, Boston, Massachusetts
| | - Lydia R Maurer
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital, Boston, Massachusetts
| | - Taylor E Lamarre
- Division of Trauma, Burn and Surgical Critical Care, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School and Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Savo Bou Zein Eddine
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital, Boston, Massachusetts
| | - Sabrina E Sanchez
- Division of Trauma, Acute Care Surgery & Surgical Critical Care, Boston University School of Medicine, Boston, Massachusetts
| | - Deepika Nehra
- Division of Trauma, Burn & Critical Care Surgery, Harborview Medical Center, University of Washington, Seattle, Washington
| | - Ali Salim
- Division of Trauma, Burn and Surgical Critical Care, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School and Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - George C Velmahos
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital, Boston, Massachusetts
| | - Haytham M A Kaafarani
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital, Boston, Massachusetts.
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Rucinski K, Leary E, Crist BD, Cook JL. Orthopaedic trauma patient non-adherence to follow-up visits at a level 1 trauma center serving an urban and rural population. Injury 2023; 54:880-886. [PMID: 36725488 DOI: 10.1016/j.injury.2023.01.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 01/17/2023] [Accepted: 01/19/2023] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To assess key demographic and psychosocial variables that may be associated with non-adherence to clinic visits following orthopaedic trauma injuries to patients in an urban and rural population. METHODS This retrospective review included all operative and non-operative patients presenting to a Level I academic trauma center serving an urban and rural population in the Midwest following an orthopaedic injury. The study tracked patient attendance to scheduled orthopaedic trauma follow-up clinic visits after a scheduled visit in the clinic following a trauma-related injury. RESULTS Data were obtained for 5816 unique orthopaedic trauma patients who had 21,066 post-treatment follow-up visits scheduled. 1627 "no-show" appointments were recorded. Factors associated with no-shows included male sex, age between 26 and 35 years, self-reported race other than white, employment listed as disabled, household income below $25,000, education less than a high school level, uninsured, Medicaid insured, and relationship status reported as single. CONCLUSIONS In the present study, key demographic and psychosocial factors were significantly associated with patient adherence to scheduled follow-up appointments after treatment for orthopaedic trauma. Identifying patients at higher risk for nonadherence will allow healthcare teams to educate patients, providers, and staff, link patients to resources to enhance adherence, and work with their institutions to develop and implement protocols for improving adherence to follow-up appointments.
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Affiliation(s)
- Kylee Rucinski
- Department of Orthopaedic Surgery, Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia MO, USA.
| | - Emily Leary
- Department of Orthopaedic Surgery, Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia MO, USA
| | - Brett D Crist
- Department of Orthopaedic Surgery, Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia MO, USA
| | - James L Cook
- Department of Orthopaedic Surgery, Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia MO, USA
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Snell DT, Lockey PD, Thompson DJ. Socioeconomic status is associated with mechanism and intent of injury in patients presenting to a UK Major Trauma Centre. Injury 2023; 54:497-501. [PMID: 36379740 DOI: 10.1016/j.injury.2022.11.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 10/31/2022] [Accepted: 11/07/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Lower socioeconomic status (SES) is linked to poorer health, health outcomes and higher rates of trauma. The aim of this study was to investigate the impact SES had on the mechanism and intent of trauma in patients presenting to a UK regional Major Trauma Centre (MTC). MATERIALS AND METHODS Trauma data from a UK MTC over a five-year period was obtained from the Trauma Audit and Research Network. Deprivation data was obtained from English Indices of Multiple Deprivation 2019 data and the study population classified into quintiles. Odds ratios were calculated, comparing mechanism and intent of trauma with each SES quintile with the least deprived quintile as the baseline for comparison. RESULTS Lower SES was associated with an increased odds ratio of undifferentiated trauma (OR 1.32, P<0.001). Falls from less than 2m constitute most trauma presentations and were not associated with SES (OR 1.09, P=0.114, 58.3% of trauma). The greater odds ratios for trauma in the socially deprived was accounted for by an increase in high-energy mechanisms and injury intents that include falls more than 2m (OR 1.75), stabbing (OR 5.18), blow injury (OR 2.75), high-risk behaviour (OR 4.61), assault (OR 6.63) and self-harm (OR 2.94) (P-values <0.001). CONCLUSION In this large, retrospective analysis of a UK MTC, we have shown that the increased risk of trauma seen with lower SES is not uniform across all mechanisms or intents and is mediated by high-energy and violent mechanisms. Targeted public health education and intervention within these demographics, appropriate to mechanisms observed as over-represented, may prove beneficial in the primary prevention of trauma, and help to guide local health service planning.
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Affiliation(s)
| | - Professor David Lockey
- Adult Intensive Care Unit, Southmead Hospital Bristol, UK; Severn Major Trauma Network, UK
| | - Dr Julian Thompson
- Adult Intensive Care Unit, Southmead Hospital Bristol, UK; Severn Major Trauma Network, UK
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Health care utilization and health-related quality of life of injury patients: comparison of educational groups. BMC Health Serv Res 2021; 21:988. [PMID: 34538243 PMCID: PMC8451142 DOI: 10.1186/s12913-021-06913-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 08/16/2021] [Indexed: 11/10/2022] Open
Abstract
Background Differences in health care utilization by educational level can contribute to inequalities in health. Understanding health care utilization and health-related quality of life (HRQoL) of educational groups may provide important insights into the presence of these inequalities. Therefore, we assessed characteristics, health care utilization and HRQoL of injury patients by educational level. Method Data for this registry based cohort study were extracted from the Dutch Injury Surveillance System. At 6-month follow-up, a stratified sample of patients (≥25 years) with an unintentional injury reported their health care utilization since discharge and completed the EQ-5-Dimension, 5-Level (EQ-5D-5L) and visual analogue scale (EQ VAS). Logistic regression analyses, adjusting for patient and injury characteristics, were performed to investigate the association between educational level and health care utilization. Descriptive statistics were used to analyse HRQoL scores by educational level, for hospitalized and non-hospitalized patients. Results This study included 2606 patients; 47.9% had a low, 24.4% a middle level, and 27.7% a high level of education. Patients with low education were more often female, were older, had more comorbidities, and lived more often alone compared to patients with high education (p < 0.001). Patients with high education were more likely to visit a general practitioner (OR: 1.38; CI: 1.11–1.72) but less likely to be hospitalized (OR: 0.79; CI: 0.63–1.00) and to have nursing care at home (OR: 0.66; CI: 0.49–0.90) compared to their low educated counterparts. For both hospitalized an non-hospitalized persons, those with low educational level reported lower HRQoL and more problems on all dimensions than those with a higher educational level. Conclusion Post-discharge, level of education was associated with visiting the general practitioner and nursing care at home, but not significantly with use of other health care services in the 6 months post-injury. Additionally, patients with a low educational level had a poorer HRQoL. However, other factors including age and sex may also explain a part of these differences between educational groups. It is important that patients are aware of potential consequences of their trauma and when and why they should consult a specific health care service after ED or hospital discharge. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06913-3.
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Park C, Bahethi R, Yang A, Gray M, Wong K, Courey M. Effect of Patient Demographics and Tracheostomy Timing and Technique on Patient Survival. Laryngoscope 2020; 131:1468-1473. [PMID: 32996189 DOI: 10.1002/lary.29000] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 07/06/2020] [Accepted: 07/19/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVES The ideal timing and technique of tracheostomy vary among patients and may impact outcomes. We aim to examine the association between tracheostomy timing, placement technique, and patient demographics on survival. STUDY DESIGN Retrospective cohort study. METHODS A retrospective review was performed for all patients who underwent tracheostomy in 2016 and 2017 at one urban academic tertiary-care hospital. Kaplan-Meier curves were created based on combinations of tracheostomy timing and technique (early percutaneous, early non-percutaneous, late percutaneous, and late non-percutaneous). Cox proportional hazard models were used to determine multivariable effects of timing, technique, and other demographic factors. Primary outcome measures were tracheostomy-related mortality and overall survival. Secondary outcomes were in-hospital, 30-day, and 90-day mortality. RESULTS Our study included 523 patients. There were six tracheostomy-related deaths, with hemorrhage and tracheoesophageal fistula being the most common causes. Tracheostomy timing and technique combinations were not associated with differences in all-cause mortality or survival following discharge. Cox proportional hazard models showed that Charlson Comorbidity Index (CCI) and unknown partner status were associated with a decrease in survival (P < .01 and P = .05, respectively). Additionally, patient age, gender, race, CCI, and body mass index were not independently associated with changes in survival. CONCLUSION Late and non-percutaneous tracheostomies were associated with more tracheostomy-related deaths, but timing and technique were not associated with differences in patient survival. Multiple regression analysis showed that increased patient comorbidities, measured via CCI, and unknown partner status were independently associated with decreased survival. Proceduralists should discuss timing, technique, and patient social factors together with the medical care team when constructing plans for postdischarge management. LEVEL OF EVIDENCE 4 Laryngoscope, 131:1468-1473, 2021.
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Affiliation(s)
| | | | - Anthony Yang
- Icahn School of Medicine at Mount Sinai, New York, USA
| | - Mingyang Gray
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Kevin Wong
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Mark Courey
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, USA
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Shi W, Anastasio A, Guisse NF, Faraj R, Fakunle OP, Easley K, Hammond KE. Impact of Insurance and Practice Type on Access to Orthopaedic Sports Medicine. Orthop J Sports Med 2020; 8:2325967120933696. [PMID: 32782900 PMCID: PMC7401157 DOI: 10.1177/2325967120933696] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 02/27/2020] [Indexed: 01/02/2023] Open
Abstract
Background: The Patient Protection Affordable Care Act has expanded Medicaid eligibility in recent years. However, the provisions of the act have not translated to improved Medicaid payments for specialists such as orthopaedic surgeons. The number of health care practitioners who accept Medicaid is already decreasing, with low reimbursement rates being cited as the primary reason for the trend. Hypothesis: Private practice orthopaedic groups will see patients with Medicaid or Medicare at lower rates than academic orthopaedic practices, and business days until appointment availability will be higher for patients with Medicaid and Medicare than those with private insurance. Study Design: Cross-sectional study. Methods: Researchers made calls to 2 regular-sized orthopaedic practices, 1 small orthopaedic practice, and 1 academic orthopaedic practice in each of the 50 states in the United States. Callers described a scenario of a recent injury resulting in a bucket-handle meniscal tear and an anterior cruciate ligament tear seen on magnetic resonance imaging at an outside emergency department. For a total of 194 practices, 3 separate telephone calls were made, each with a different insurance type. Data regarding insurance acceptance and business days until appointment were tabulated. Student t tests or analysis of variance for continuous data and χ2 or Fisher exact tests for categorical data were utilized. Results: After completing 582 telephone calls, it was determined that 31.4% (n = 59) did not accept Medicaid, compared with 2.2% (n = 4) not accepting Medicare and 1% (n = 1) not accepting private insurance (P < .001). There was no significant association between type of practice and Medicaid refusal (P = 0.12). Mean business days until appointment for Medicaid, Medicare, and private insurance were 5.3, 4.1, and 2.9, respectively (P < .001). Conclusions: Access to care remains a significant burden for the Medicaid population, given a rate of Medicaid refusal of 32.2% across regular-sized orthopaedic practices. If Medicaid is accepted, time until appointment was significantly longer when compared with private insurance.
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Cook A, Harris R, Brown HE, Bedrick E. Geospatial characteristics of non-motor vehicle and assault-related trauma events in greater Phoenix, Arizona. Inj Epidemiol 2020; 7:34. [PMID: 32536346 PMCID: PMC7294629 DOI: 10.1186/s40621-020-00258-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 05/04/2020] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Injury-causing events are not randomly distributed across a landscape, but how they are associated with the features and characteristics of the places where they occur in Arizona (AZ) remains understudied. Clustering of trauma events and associations with areal sociodemographic characteristics in the greater Phoenix (PHX), AZ region can promote understanding and inform efforts to ameliorate a leading cause of death and disability for Arizonans. The outcomes of interest are trauma events unrelated to motor vehicle crashes (MVC) and the subgroup of trauma events due to interpersonal assaults. METHODS A retrospective, ecological study was performed incorporating data from state and national sources for the years 2013-2017. Geographically weighted regression models explored associations between the rates of non-MVC trauma events (n/10,000 population) and the subgroup of assaultive trauma events per 1000 and areal characteristics of socioeconomic deprivation (areal deprivation index [ADI]), the density of retail alcohol outlets for offsite consumption, while controlling for race/ethnicity, population density, and the percentage urban population. RESULTS The 63,451 non-MVC traumas within a 3761 mile2 study area encompassing PHX and 22 surrounding communities, an area with nearly 60% of the state's population and 54% of the trauma events in the AZ State Trauma Registry for the years 2013-2017. Adjusting for confounders, ADI was associated with the rates of non-MVC and assaultive traumas in all census block groups studied (mean coefficients 0.05 sd. 0.001 and 0.07 sd. 0.002 for non-MVC and assaultive trauma, respectively). Alcohol retail outlet density was also associated with non-MVC and assaultive traumas in fewer block groups compared to ADI. CONCLUSION Socioeconomic deprivation and alcohol outlet density were associated with injury producing events in the greater PHX area. These features persist in the environment before and after the traumas occur. Ongoing research is warranted to identify the most influential areal predictors of traumatic injury-causing events in the greater PHX area to inform and geographically target prevention initiatives.
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Affiliation(s)
- Alan Cook
- Department of Epidemiology and Biostatistics, University of Texas Health Science Center Tyler School of Community and Rural Health, 11937 U.S. Highway 271, H252, Tyler, TX 75708 USA
| | - Robin Harris
- Department of Epidemiology and Biostatistics, University of Arizona Mel and Enid Zuckerman College of Public Health, 1295 N. Martin Ave., Drachman Hall, Tucson, AZ 85724 USA
| | - Heidi E. Brown
- Department of Epidemiology and Biostatistics, University of Arizona Mel and Enid Zuckerman College of Public Health, 1295 N. Martin Ave., Drachman Hall, Tucson, AZ 85724 USA
| | - Edward Bedrick
- Department of Epidemiology and Biostatistics, University of Arizona Mel and Enid Zuckerman College of Public Health, 1295 N. Martin Ave., Drachman Hall, Tucson, AZ 85724 USA
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Othman S, Cohn JE, Toscano M, Shokri T, Zwillenberg S. Substance Use and Maxillofacial Trauma: A Comprehensive Patient Profile. J Oral Maxillofac Surg 2019; 78:235-240. [PMID: 31783005 DOI: 10.1016/j.joms.2019.10.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 10/14/2019] [Accepted: 10/25/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE Maxillofacial trauma confers an increased risk of long-term clinical sequelae with a substantial economic burden on the health care system. Substance use has long been correlated with an increased risk of trauma, yet to date, a comprehensive profile of substance users incurring facial fractures has not been established. We aimed to establish patterns and trends of substance use and specific substances in the setting of maxillofacial trauma. PATIENTS AND METHODS A retrospective chart review was conducted at our institution examining patients with maxillofacial fractures from 2016 to 2017. Information on age, gender, race, urine drug screen status, setting of presentation, mechanism of injury, trauma history, and injury severity was collected and examined for associations with particular substances. RESULTS We included 388 patients for analysis. Patients with positive urine drug screen results were significantly more likely to be men, present in an urban setting, incur poly-facial trauma, and have a history of facial trauma. In addition, alcohol use correlated significantly with injury severity in the context of polytrauma. Living in an urban setting and using phencyclidine were both significantly associated with a history of maxillofacial trauma. CONCLUSIONS Patients with comorbid maxillofacial trauma and substance use exhibit particular patterns in presentation and history. Establishing a profile for these patients allows for the development of prevention and rehabilitation programs.
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Affiliation(s)
- Sammy Othman
- Medical Student, Drexel University College of Medicine, Philadelphia, PA.
| | - Jason E Cohn
- Resident, Department of Otolaryngology-Head and Neck Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, PA
| | - Michael Toscano
- Medical Student, New York Institute of Technology College of Osteopathic Medicine, Glen Head, NY
| | - Tom Shokri
- Resident, Department of Otolaryngology-Head and Neck Surgery, Penn State Hershey Medical Center, Hershey, PA
| | - Seth Zwillenberg
- Professor, Department of Otolaryngology-Head and Neck Surgery, Einstein Medical Center, Philadelphia, PA
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Murphy PB, Severance S, Savage S, Obeng-Gyasi S, Timsina LR, Zarzaur BL. Financial toxicity is associated with worse physical and emotional long-term outcomes after traumatic injury. J Trauma Acute Care Surg 2019; 87:1189-1196. [PMID: 31233442 PMCID: PMC6815224 DOI: 10.1097/ta.0000000000002409] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Increasing health care costs and high deductible insurance plans have shifted more responsibility for medical costs to patients. After serious illnesses, financial responsibilities may result in lost wages, forced unemployment, and other financial burdens, collectively described as financial toxicity. Following cancer treatments, financial toxicity is associated with worse long-term health-related quality of life (HRQoL) outcomes. The purpose of this study was to determine the incidence of financial toxicity following injury, factors associated with financial toxicity, and the impact of financial toxicity on long-term HRQoL. METHODS Adult patients with an Injury Severity Score of 10 or greater and without head or spinal cord injury were prospectively followed for 1 year. The Short-Form-36 was used to determine overall quality of life at 1 month, 2 months, 4 months, and 12 months. Screens for depression and posttraumatic stress syndrome were administered. The primary outcome was any financial toxicity. A multivariable generalized estimating equation was used to account for variability over time. RESULTS Five hundred patients were enrolled, and 88% suffered financial toxicity during the year following injury (64% reduced income, 58% unemployment, 85% experienced stress due to financial burden). Financial toxicity remained stable over follow-up (80-85%). Factors independently associated with financial toxicity were lower age (odds ratio [OR], 0.96 [0.94-0.98]), lack of health insurance (OR, 0.28 [0.14-0.56]), and larger household size (OR, 1.37 [1.06-1.77]). After risk adjustment, patients with financial toxicity had worse HRQoL, and more depression and posttraumatic stress syndrome in a stepwise fashion based on severity of financial toxicity. CONCLUSION Financial toxicity following injury is extremely common and is associated with worse psychological and physical outcomes. Age, lack of insurance, and large household size are associated with financial toxicity. Patients at risk for financial toxicity can be identified, and interventions to counteract the negative effects should be developed to improve long-term outcomes. LEVEL OF EVIDENCE Prognostic/epidemiologic study, level III.
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Affiliation(s)
- Patrick B Murphy
- From the Department of Surgery (P.T.M., S.Se., S.O.-G., L.R.T., B.L.Z.), Indiana University School of Medicine, Indianapolis, Indiana; and Department of Surgery (S.Sa.), University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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Schrecker T, Milne E. More uncertainty about public health and reducing inequalities. J Public Health (Oxf) 2018; 40:671-672. [PMID: 30590770 DOI: 10.1093/pubmed/fdy212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Indexed: 11/14/2022] Open
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