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Sun KJ, Zhu KY, Moon TJ, Breslin MA, Ho VP, Vallier HA. Recovery Services for Interpersonal Violence Victims on Healthcare Use at a Trauma Center. J Surg Res 2024; 293:443-450. [PMID: 37812878 DOI: 10.1016/j.jss.2023.08.037] [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: 02/28/2023] [Revised: 07/19/2023] [Accepted: 08/26/2023] [Indexed: 10/11/2023]
Abstract
INTRODUCTION Treatment of interpersonal violence (IPV) patients is often complicated by social and mental health comorbidities. New American College of Surgeons (ACS) requirements include provision of psychosocial support services for recovery after injury. We aim to describe utilization and patient outcomes after provision of Trauma Recovery Services (TRS) at our institution for the IPV population. These services include assistance with food, housing, criminal justice, and advocacy. METHODS IPV patients were identified between September 6, 2018 and December 20, 2020. Demographic information was collected. TRS utilization and specific services rendered were identified. Primary outcome measures included initial length of stay (LOS), number of subsequent emergency department (ED) visits, and outpatient visits within 1 y after the initial injury. Statistical analyses included t-tests, Chi-squared tests, and multivariate regression analyses. RESULTS A total of 502 patients were included in the final cohort, and 394 patients (78.5%) accepted the utilization of TRS services after initial interaction. Patients were on average 33.4 y old, and 59.4% were females. Patients who were older (P < 0.001) and homeless (P = 0.004) were more likely to use TRS, while victims of sexual assault (P < 0.001) and single patients (P = 0.041) were less likely. Patients who utilized TRS had longer initial LOS (P < 0.001), more ED visits (P < 0.001), and more outpatient visits (P = 0.01) related to the initial complaint, independent of potential confounders on multivariate linear regression. Food and housing service utilization associated with LOS (P = 0.01), ED visits (P < 0.001), and outpatient visits (P < 0.001). Additionally, transportation services were associated with longer LOS (P = 0.01) while patient advocacy services were associated with more ED visits (P = 0.03). CONCLUSIONS TRS was extensively utilized by IPV patients, and associated with more follow-up appointments, ED visits, and longer LOS. Emphasis on injury mechanisms, baseline demographics, and social features may further characterize patients in need who tend toward utilization.
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Affiliation(s)
- Kristie J Sun
- MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Kevin Y Zhu
- MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Tyler J Moon
- MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Mary A Breslin
- MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Vanessa P Ho
- MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Heather A Vallier
- MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio.
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Heimke IM, Furdock R, Simske NM, Swetz A, Simpson M, Breslin MA, Hendrickson SB, Moore TA, Vallier HA. Trauma recidivism is reduced with engagement in psychosocial programming following orthopaedic trauma. Injury 2023; 54:111129. [PMID: 37880032 DOI: 10.1016/j.injury.2023.111129] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 10/12/2023] [Accepted: 10/13/2023] [Indexed: 10/27/2023]
Abstract
INTRODUCTION Recidivism is common following injury. Interventions to enhance patient engagement may reduce trauma recidivism. Education, counseling, peer mentorship, and other resources are known as Trauma Recovery Services (TRS). The authors hypothesized that TRS use would reduce trauma recidivism. METHODS Over five years at a level 1 trauma center, 954 adults treated operatively for pelvic, spine, and femoral fractures were reviewed. Recidivism was defined as return to trauma center for new injury within 30-months. All patients were offered TRS. Multivariate logistic regression statistical analysis was used to identify predictors of recidivism. RESULTS Three hundred and ninety-seven of all patients (42 %) utilized TRS, including educational materials (n = 293), peer visits (n = 360), coaching (n = 284), posttraumatic stress disorder (PTSD) screening (n = 74), and other services. Within the entire sample, 136 patients (14 %) returned to the emergency department for an unrelated trauma event after mean 21 months. 13 % of TRS users became recidivists. Overall, 49 % of recidivists had history of pre-existing mental illness. High rates of TRS engagement between recidivists and non-recidivists were seen (75 %); however, non-recidivists were more likely to use multiple types of recovery services (49 % vs 34 %, p = 0.002), and were more likely to engage with trauma peer mentors (former trauma survivors) more than once (91 % vs 81 %, p = 0.03). After multivariable analysis, patients using multiple different recovery services had a lower risk of recidivism (p = 0.04, OR 0.42, 95 % CI [0.19-0.96]). CONCLUSIONS Multifaceted engagement with recovery programming is associated with less recidivism following trauma. Future study of resultant reductions in healthcare costs are warranted. LEVEL OF EVIDENCE Level II; Prognostic.
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Affiliation(s)
- Isabella M Heimke
- MetroHealth Medical Center, Western Reserve University, Cleveland, OH, United States
| | - Ryan Furdock
- MetroHealth Medical Center, Western Reserve University, Cleveland, OH, United States
| | - Natasha M Simske
- MetroHealth Medical Center, Western Reserve University, Cleveland, OH, United States
| | - Anna Swetz
- MetroHealth Medical Center, Western Reserve University, Cleveland, OH, United States
| | - Megen Simpson
- MetroHealth Medical Center, Western Reserve University, Cleveland, OH, United States
| | - Mary A Breslin
- MetroHealth Medical Center, Western Reserve University, Cleveland, OH, United States
| | - Sarah B Hendrickson
- MetroHealth Medical Center, Western Reserve University, Cleveland, OH, United States
| | - Timothy A Moore
- MetroHealth Medical Center, Western Reserve University, Cleveland, OH, United States
| | - Heather A Vallier
- MetroHealth Medical Center, Western Reserve University, Cleveland, OH, United States.
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Jang A, Thomas A, Slocum J, Tesorero K, Danna G, Saklecha A, Wafford E, Regan S, Stey AM. The gap between hospital-based violence intervention services and client needs: A systematic review. Surgery 2023; 174:1008-1020. [PMID: 37586893 DOI: 10.1016/j.surg.2023.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 06/22/2023] [Accepted: 07/08/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND Survivors of intentional interpersonal violence face social challenges related to social determinants of health that led to their initial injury. Hospital-based violence intervention programs reduce reinjury. It is unclear how well they meet clients' reported needs. This systematic review aimed to quantify how well hospital-based violence intervention program services addressed clients' reported needs. METHODS Medline, The Cochrane Library, CINAHL Plus with Full Text, and PsycInfo were queried for studies addressing hospital-based violence intervention programs services and intentional injury survivors' needs in the United States. Case reports, reviews, editorials, theses, and studies focusing on pediatric patients, victims of intimate partner violence, or sexual assault were excluded. Data extracted included program structure, hospital-based violence intervention program services, and client needs assessments before and after receiving hospital-based violence intervention program services. RESULTS Of the 3,339 citations identified, 13 articles were selected for inclusion. Hospital-based violence intervention programs clients' most reported needs included mental health (10 studies), employment (7), and education (5) before receiving hospital-based violence intervention programs services. Only 4 studies conducted quantitative client needs assessments before and after receiving hospital-based violence intervention program services. All 4 studies were able to meet at least 50% of each of the clients' reported needs. The success rate depended on the need and program location: success in meeting mental health needs ranged from 65% to 90% of clients. Conversely, time-intensive long-term needs were least met, including employment 60% to 86% of clients, education 47% to 73%, and housing 50% to 71%. CONCLUSION Few hospital-based violence intervention programs studies considered clients' reported needs. Employment, education, and housing must be a stronger focus of hospital-based violence intervention programs.
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Affiliation(s)
- Angie Jang
- Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Arielle Thomas
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI. https://twitter.com/ac_thomas7
| | - John Slocum
- Feinberg School of Medicine, Northwestern University, Chicago, IL
| | | | - Giovanna Danna
- Chicago Medical School, Rosalind Franklin University, North Chicago, IL
| | - Anjay Saklecha
- Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Eileen Wafford
- Galter Health Sciences Librarian and Learning Center, Feinberg School of Medicine, Northwestern University
| | | | - Anne M Stey
- Feinberg School of Medicine, Northwestern University, Chicago, IL.
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Heimke IM, Connelly M, Clarke A, De Mario B, Breslin MA, Furdock R, Moore TA, Vallier HA. Recidivism after orthopaedic trauma has diminished over time. Eur J Trauma Emerg Surg 2023; 49:1891-1896. [PMID: 37162555 PMCID: PMC10170426 DOI: 10.1007/s00068-023-02274-0] [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: 01/24/2023] [Accepted: 05/02/2023] [Indexed: 05/11/2023]
Abstract
PURPOSE The purpose was to analyze our trauma population during two periods to assess for predictors of recidivism. METHODS Prior (2007-2011, n = 879) and recent (2014-2019, n = 954) orthopaedic trauma patients were reviewed. Recidivists were those returning with an unrelated injury. Recidivism rates were compared, and factors associated with recidivism were identified. RESULTS Recidivism decreased: 18.7% to 14.3% (p = 0.01). Mean age and sex of the two cohorts were not different. Recent recidivists were more likely to sustain gunshot wound (GSW) injuries (22.1% vs 18.9%, p = 0.09), and mental illness was more common (56.6% vs 28.1%, p < 0.0001). The recent recidivist population was less often married (12.9% vs 23.8%, p = 0.03), and both recidivist groups were often underinsured (Medicaid or uninsured: (60.6% vs 67.0%)). CONCLUSION Recidivism diminished, although more GSW and mental illness were seen. Recidivists are likely to be underinsured. The changing profile of recidivists may be attributed to socioeconomic trends and new programs to improve outcomes after trauma.
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Affiliation(s)
- Isabella M Heimke
- Department of Orthopaedic Surgery, Case Western Reserve University, Cleveland, OH, 44109, USA
| | - Madison Connelly
- Department of Orthopaedic Surgery, Case Western Reserve University, Cleveland, OH, 44109, USA
| | - Amelia Clarke
- Department of Orthopaedic Surgery, Case Western Reserve University, Cleveland, OH, 44109, USA
| | - Belinda De Mario
- Department of Orthopaedic Surgery, Case Western Reserve University, Cleveland, OH, 44109, USA
| | - Mary A Breslin
- Department of Orthopaedic Surgery, Case Western Reserve University, Cleveland, OH, 44109, USA
| | - Ryan Furdock
- Department of Orthopaedic Surgery, Case Western Reserve University, Cleveland, OH, 44109, USA
| | - Timothy A Moore
- Department of Orthopaedic Surgery, Case Western Reserve University, Cleveland, OH, 44109, USA
| | - Heather A Vallier
- Department of Orthopaedic Surgery, Case Western Reserve University, Cleveland, OH, 44109, USA.
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Abstract
SUMMARY Trauma is a major public health issue. Orthopaedic trauma surgeons are skilled in the acute management of musculoskeletal injury; however, formal training and resources have not been devoted to optimizing recovery after trauma. Recovery entails addressing the biomedical aspects of injury, as well as the psychological and social factors. The purposes of this study were to describe existing programs and resources within trauma centers, developed to promote psychosocial recovery. Supporting research data will be referenced, and potential barriers to program implementation will be discussed. The American College of Surgeons has mandated screening and treatment for mental illness after trauma, which will raise the bar to highlight the importance of these social issues, likely enabling providers to develop new programs and other resources within their systems. Provider education will promote the informing of patients and families, with the intent of enhancing the efficiency and scope of recovery.
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