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Biesboer EA, Brandolino A, Servi A, Laszkiewicz R, Herbst L, Cronn S, Cadman J, Trevino C, deRoon-Cassini T, Schroeder ME. A pilot project of a Post Discharge Care Team for firearm injury survivors decreases emergency department utilization, hospital readmission days, and cost. J Trauma Acute Care Surg 2024; 97:134-141. [PMID: 38497907 DOI: 10.1097/ta.0000000000004299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
BACKGROUND Persons of low socioeconomic status are overrepresented in the firearm injury patient population and may experience challenges in accessing complex outpatient health systems. Consequently, outpatient care for these patients is plagued by poor follow-up and increased emergency department (ED) utilization. We developed a Post Discharge Care Team (PDCT) consisting of a dedicated trauma nurse navigator and medical social worker to bridge the gap between hospital discharge and outpatient care to improve recovery. METHODS Adult firearm injury survivors admitted to the trauma service were randomized 1:1 to receive either PDCT services or standard of care (SOC) workflows. The PDCT nurse provided education and set expectations regarding injuries, wound care, and outpatient follow-up. The PDCT social worker performed a comprehensive assessment to identify concerns including housing and financial instability, food insecurity, or transportation issues. The primary outcome was ED utilization, with secondary outcomes including readmissions and overall health care costs compared between groups. RESULTS In the first 6 months of the study, a total of 44 patients were randomized to PDCT and 47 to SOC. There were 10 patients who visited the ED in the PDCT group compared with 16 in the SOC group ( p = 0.23) for a total of 14 and 23 ED visits, respectively. There were 14 patients in the PDCT and 11 patients in the SOC groups who were readmitted ( p = 0.31), but the PDCT group was readmitted for 27.9 fewer hospital days. After accounting for programmatic costs, the PDCT had a hospital savings of $34,542.71. CONCLUSION A collaborative, specialized PDCT for firearm injury survivors consisting of a dedicated trauma nurse navigator and medical social worker decreased outpatient ED utilization, readmission days, and was cost effective. Trauma centers with high volumes of penetrating trauma should consider a similar model to improve outpatient care for firearm injury survivors. LEVEL OF EVIDENCE Therapeutic/Care Management; Level III.
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Affiliation(s)
- Elise A Biesboer
- From the Division of Trauma and Acute Care Surgery, Department of Surgery (E.A.B., A.B., A.S., R.L., L.H., S.C., J.C., C.T., T.d.R.-C., M.E.S.), and Comprehensive Injury Center, Medical College of Wisconsinn (T.d.R.-C.), Milwaukee, Wisconsin
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Rascoe AS. CORR Insights®: Can Patient-centered Education and Pain Management Delivered by Coaches Improve Pain Outcomes After Orthopaedic Trauma? A Randomized Trial. Clin Orthop Relat Res 2024:00003086-990000000-01645. [PMID: 38905445 DOI: 10.1097/corr.0000000000003160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Accepted: 05/30/2024] [Indexed: 06/23/2024]
Affiliation(s)
- Alexander S Rascoe
- Assistant Professor, Department of Orthopaedic Surgery, Case Western Reserve University, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
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Landy DC, Mounce SD, Sabatini FM, Chapek JA, Conley CE, Duncan ST. Randomized Controlled Trial of Irrigation-Coupled Bipolar Electrocautery Versus Tourniquet in Total Knee Arthroplasty. Arthroplast Today 2024; 27:101364. [PMID: 39071836 PMCID: PMC11282416 DOI: 10.1016/j.artd.2024.101364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 02/08/2024] [Accepted: 02/26/2024] [Indexed: 07/30/2024] Open
Abstract
Background Recovery from total knee arthroplasty remains arduous for some patients, prompting interest in perioperative management. While tourniquet use is not associated with longer-term outcomes, its effect on quadriceps strength in the immediate postoperative window is unknown. Methods A single-center, double-blind, randomized controlled trial of 66 patients undergoing primary total knee arthroplasty from 2019 to 2022 was performed to compare the use of an irrigation-coupled bipolar device (ICBD) and no tourniquet (ICBD group, N = 34) to tourniquet use with no ICBD (tourniquet group, N = 32). Groups were similar with respect to age, sex, and obesity. The primary outcome was quadriceps strength at 2 weeks, measured using a handheld dynamometer and standardized to the contralateral side. Knee Injury and Osteoarthritis Outcome Score for Joint Replacement was measured with the difference from baseline serving as a secondary outcome. Comparisons were performed using the Student's t-test. Results Only 28 patients, 14 in each group, had primary outcome data. At 2-weeks, quadriceps strength was higher in the ICBD group compared to the tourniquet group (83% vs 70%), though not statistically significant (P = .16). There was no difference between the ICBD and tourniquet groups in Knee Injury and Osteoarthritis Outcome Score for Joint Replacement changed at 2-weeks (13 vs 10, P = .37) or 6-weeks (16 vs 17, P = .76). Conclusions Tourniquet use was associated with a small but not statistically significant difference in quadriceps strength at 2 weeks that may justify further study given the loss of power here. There can be limitations to conducting randomized controlled trials that are important for early-career investigators to consider and that were magnified due to COVID-related restrictions in the present study, which we discuss. Level of Evidence Level II.
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Affiliation(s)
- David C. Landy
- Department of Orthopaedic Surgery & Sports Medicine, University of Kentucky, Lexington, KY, USA
| | - Samuel D. Mounce
- Department of Orthopaedic Surgery & Sports Medicine, University of Kentucky, Lexington, KY, USA
| | - Franco M. Sabatini
- Department of Orthopaedic Surgery & Sports Medicine, University of Kentucky, Lexington, KY, USA
| | - Jeffrey A. Chapek
- Department of Orthopaedic Surgery & Sports Medicine, University of Kentucky, Lexington, KY, USA
| | - Caitlin E. Conley
- Department of Orthopaedic Surgery & Sports Medicine, University of Kentucky, Lexington, KY, USA
| | - Stephen T. Duncan
- Department of Orthopaedic Surgery & Sports Medicine, University of Kentucky, Lexington, KY, USA
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Gillinov SM, Kim DN, Islam W, Lee MS, Moran J, Fong S, Mahatme RJ, McLaughlin WM, Maldonado DR, Medvecky MJ, Grauer JN, Jimenez AE. Medicaid Insurance Is Associated With More Complications and Emergency Department Visits but Equivalent 5-Year Secondary Surgery Rate After Primary Hip Arthroscopy. Arthroscopy 2024; 40:1117-1125. [PMID: 37597701 DOI: 10.1016/j.arthro.2023.08.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 08/03/2023] [Accepted: 08/03/2023] [Indexed: 08/21/2023]
Abstract
PURPOSE To compare 90-day complications, 30-day emergency department (ED) visits, and 5-year rate of secondary surgeries for patients with Medicaid vs commercial insurance undergoing primary hip arthroscopy for femoroacetabular impingement syndrome (FAIS) and/or labral tears using a large national database. METHODS The PearlDiver Mariner151 database was used to identify patients with International Classification of Diseases, Tenth Revision diagnosis codes for FAIS and/or labral tear who underwent primary hip arthroscopy with femoroplasty, acetabuloplasty, and/or labral repair between 2015 and 2021. Patients with Medicaid were matched 1:4 to a control group of commercially insured patients based on age, sex, body mass index, and Elixhauser Comorbidity Index. Rates of 90-day complications and 30-day ED visits were compared using multivariate regression models. Five-year rates of secondary surgeries-revision arthroscopy or total hip arthroplasty-were compared between cohorts by Kaplan-Meier analysis. RESULTS A total of 2,033 Medicaid patients were matched with 8,056 commercially insured patients. Rates of adverse events were low; however, Medicaid patients were significantly more likely than commercially insured patients to experience any 90-day complication (2.12% vs 1.43%; odds ratio [OR], 1.2; P = .02). Medicaid patients also experienced more 30-day ED visits than commercially insured patients (8.61% vs 4.28%), and on multivariate logistic regression, insurance status was the strongest determinant of 30-day ED visits (relative to commercial, Medicaid OR, 2.02; P < .001). Despite these differences, 5-year rates of secondary surgeries were comparable between groups (6.1% vs 6.0%; P = .6). CONCLUSIONS In this large national database study, Medicaid patients undergoing primary hip arthroscopy showed significantly greater odds of experiencing 90-day postoperative complications and 30-day ED visits compared to commercially insured patients. Nevertheless, both groups had similar survivorship rates at 5-year follow-up, similar to prior estimates irrespective of insurance. These results document encouraging secondary surgery rates in Medicaid patients.
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Affiliation(s)
- Stephen M Gillinov
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, USA.
| | - David N Kim
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, USA
| | - Wasif Islam
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, USA
| | - Michael S Lee
- Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Jay Moran
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, USA
| | - Scott Fong
- Advanced Orthopedics and Sports Medicine, San Francisco, California, USA
| | - Ronak J Mahatme
- University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - William M McLaughlin
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, USA
| | - David R Maldonado
- Department of Orthopaedic Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Michael J Medvecky
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, USA
| | - Jonathan N Grauer
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, USA
| | - Andrew E Jimenez
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, USA
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Bauerle WB, Reese V, Stoltzfus J, Benton A, Knipe J, Wilde-Onia R, Castillo R, Thomas P, Cipolla J, Braverman MA. Effect of Standardized Reminder Calls on Trauma Patient No-Show Rate. J Am Coll Surg 2024; 238:236-241. [PMID: 37861231 DOI: 10.1097/xcs.0000000000000898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
BACKGROUND Most patients who sustain a traumatic injury require outpatient follow-up. A common barrier to outpatient postadmission care is patient failure to follow-up. One of the most significant factors resulting in failure to follow-up is age more than 35 years. Recent work has shown that follow-up telephone calls reduce readmission rates. Our aim was to decrease no-show appointments by 10% in 12 months. STUDY DESIGN The electronic medical records at our level I and II trauma centers were queried for all outpatient appointments for trauma between July 1, 2020, and June 9, 2021, and whether the patient attended their follow-up appointment. Patients with visits scheduled after August 1, 2021, received 24- and 48-hour previsit reminder calls. Patients with visits scheduled between July 1, 2020, and August 1, 2021, did not receive previsit calls. Both groups were compared using multivariable direct logistic regression models. RESULTS A total of 1,822 follow-up opportunities were included in the study. During the pre-implementation phase, there was a no-show rate of 30.9% (329 of 1,064 visits). Postintervention, a 12.2% reduction in overall no-show rate occurred. A statistically significant 11.2% decrease (p < 0.001) was seen in elderly patients. Multivariate analysis showed standardized calls resulted in significantly decreased odds of failing to keep an appointment (adjusted odds ratio = 0.610, p < 0.001). CONCLUSIONS Reminder calls led to a 12.2% reduction in no-show rate and were an independent predictor of a patient's likelihood of attending their appointment. Other predictors of attendance included insurance status and abdominal injury.
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Affiliation(s)
- Wayne B Bauerle
- From the Department of Surgery (Bauerle), St. Luke's University Health Network, Bethlehem, PA
| | - Vanessa Reese
- Department of Research and Innovation (Reese), St. Luke's University Health Network, Bethlehem, PA
| | - Jill Stoltzfus
- Department of Graduate Medical Education (Stoltzfus), St. Luke's University Health Network, Bethlehem, PA
| | - Adam Benton
- Department of Surgery, Division of Trauma and Acute Care Surgery (Benton, Knipe, Wilde-Onia, Castilllo, Thomas, Cipolla, Braverman), St. Luke's University Health Network, Bethlehem, PA
| | - Joshua Knipe
- Department of Surgery, Division of Trauma and Acute Care Surgery (Benton, Knipe, Wilde-Onia, Castilllo, Thomas, Cipolla, Braverman), St. Luke's University Health Network, Bethlehem, PA
- Department of Trauma Surgery (Knipe, Wilde-Onia, Castillo, Thomas, Cipolla, Braverman), St. Luke's University Health Network, Bethlehem, PA
| | - Rebecca Wilde-Onia
- Department of Surgery, Division of Trauma and Acute Care Surgery (Benton, Knipe, Wilde-Onia, Castilllo, Thomas, Cipolla, Braverman), St. Luke's University Health Network, Bethlehem, PA
- Department of Trauma Surgery (Knipe, Wilde-Onia, Castillo, Thomas, Cipolla, Braverman), St. Luke's University Health Network, Bethlehem, PA
| | - Roberto Castillo
- Department of Surgery, Division of Trauma and Acute Care Surgery (Benton, Knipe, Wilde-Onia, Castilllo, Thomas, Cipolla, Braverman), St. Luke's University Health Network, Bethlehem, PA
- Department of Trauma Surgery (Knipe, Wilde-Onia, Castillo, Thomas, Cipolla, Braverman), St. Luke's University Health Network, Bethlehem, PA
| | - Peter Thomas
- Department of Surgery, Division of Trauma and Acute Care Surgery (Benton, Knipe, Wilde-Onia, Castilllo, Thomas, Cipolla, Braverman), St. Luke's University Health Network, Bethlehem, PA
- Department of Trauma Surgery (Knipe, Wilde-Onia, Castillo, Thomas, Cipolla, Braverman), St. Luke's University Health Network, Bethlehem, PA
| | - James Cipolla
- Department of Surgery, Division of Trauma and Acute Care Surgery (Benton, Knipe, Wilde-Onia, Castilllo, Thomas, Cipolla, Braverman), St. Luke's University Health Network, Bethlehem, PA
- Department of Trauma Surgery (Knipe, Wilde-Onia, Castillo, Thomas, Cipolla, Braverman), St. Luke's University Health Network, Bethlehem, PA
| | - Maxwell A Braverman
- Department of Surgery, Division of Trauma and Acute Care Surgery (Benton, Knipe, Wilde-Onia, Castilllo, Thomas, Cipolla, Braverman), St. Luke's University Health Network, Bethlehem, PA
- Department of Trauma Surgery (Knipe, Wilde-Onia, Castillo, Thomas, Cipolla, Braverman), St. Luke's University Health Network, Bethlehem, PA
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Bender M, Jain N, Giron A, Harder J, Rounds A, Mackay B. Factors Influencing Compliance to Follow-up Visits in Orthopaedic Surgery. J Am Acad Orthop Surg Glob Res Rev 2024; 8:01979360-202401000-00012. [PMID: 38290111 PMCID: PMC10830078 DOI: 10.5435/jaaosglobal-d-23-00140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 10/11/2023] [Accepted: 12/19/2023] [Indexed: 02/01/2024]
Abstract
BACKGROUND Orthopaedic procedures require postoperative follow-up to maximize recovery. Missed appointments and noncompliance can result in complications and increased healthcare costs. This study investigates the relationship between patient postoperative visit attendance and the distance traveled to receive care. MATERIALS AND METHODS A retrospective review of all surgeries performed by a single orthopaedic surgeon in 2019 at level 1 trauma center in a midsized city serving a largely rural population was completed. We excluded patients who underwent another subsequent procedure. Distance to care and time traveled were determined by the patient's address and the clinic address using Google Maps Application Programming Interface. Other variables that may affect attendance at follow-up visits were also collected. Univariate and multivariate logistic regression was done with purposeful selection. RESULTS We identified 518 patients of whom 32 (6%) did not attend their first scheduled follow-up appointment. An additional 47 (10%) did not attend their second follow-up. In total, 79 patients (15%) did not attend one of their appointments. Younger age, male sex, Black or African American race, self-pay, Medicaid insurance, accident insurance, and increased distance were individual predictors of missing an appointment. In the final multivariate logistic regression model, male sex (OR 1.74), Black or African American race (OR 2.78), self-pay (OR 3.12), Medicaid (OR 3.05), and traveling more than 70 miles to clinic (OR 2.02) markedly predicted missing an appointment, while workers' compensation (OR 0.23) predicted attendance. DISCUSSION Several nonmodifiable patient factors predict patient noncompliance in attending orthopaedic postoperative visits. When patients are considered at high risk of being lost to follow-up, there may be an opportunity to implement interventions to improve follow-up rate and patient outcomes, minimize patient costs, and maximize profitability for the hospital.
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Affiliation(s)
- Matthew Bender
- From the Department of Orthopedic Surgery, Texas Tech University Health Sciences Center, Lubbock, TX
| | - Neil Jain
- From the Department of Orthopedic Surgery, Texas Tech University Health Sciences Center, Lubbock, TX
| | - Alec Giron
- From the Department of Orthopedic Surgery, Texas Tech University Health Sciences Center, Lubbock, TX
| | - Justin Harder
- From the Department of Orthopedic Surgery, Texas Tech University Health Sciences Center, Lubbock, TX
| | - Alexis Rounds
- From the Department of Orthopedic Surgery, Texas Tech University Health Sciences Center, Lubbock, TX
| | - Brendan Mackay
- From the Department of Orthopedic Surgery, Texas Tech University Health Sciences Center, Lubbock, TX
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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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Shilati FM, Silver CM, Baskaran A, Jang A, Wafford QE, Slocum J, Schilling C, Schaeffer C, Shapiro MB, Stey AM. Transitional care programs for trauma patients: A scoping review. Surgery 2023; 174:1001-1007. [PMID: 37550166 PMCID: PMC10527729 DOI: 10.1016/j.surg.2023.06.038] [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: 05/16/2023] [Accepted: 06/18/2023] [Indexed: 08/09/2023]
Abstract
BACKGROUND Transitional care programs establish comprehensive outpatient care after hospitalization. This scoping review aimed to define participant characteristics and structure of transitional care programs for injured adults as well as associated readmission rates, cost of care, and follow-up adherence. METHODS We conducted a scoping review in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews standard. Information sources searched were Medline, the Cochrane Library, CINAHL, and Scopus Plus with Full Text. Eligibility criteria were systematic reviews, clinical trials, and observational studies of transitional care programs for injured adults in the United States, published in English since 2000. Two independent reviewers screened all full texts. A data charting process extracted patient characteristics, program structure, readmission rates, cost of care, and follow-up adherence for each study. RESULTS A total of 10 studies described 9 transitional care programs. Most programs (60%) were nurse/social-worker-led post-discharge phone call programs that provided follow-up reminders and inquired regarding patient concerns. The remaining 40% of programs were comprehensive interdisciplinary case-coordination transitional care programs. Readmissions were reduced by 5% and emergency department visits by 13% among participants of both types of programs compared to historic data. Both programs improved follow-up adherence by 75% compared to historic data. CONCLUSION Transitional care programs targeted at injured patients vary in structure and may reduce overall health care use.
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Affiliation(s)
| | - Casey M Silver
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL.
| | - Archit Baskaran
- Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Angie Jang
- Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Q Eileen Wafford
- Galter Health Sciences Library and Learning Center, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - John Slocum
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Christine Schilling
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Christine Schaeffer
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago IL
| | - Michael B Shapiro
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Anne M Stey
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL. https://twitter.com/AnneMStey
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Kenawy DM, Breslin LM, Chen JC, Tamimi MM, North JK, Abdel-Rasoul M, Noria SF. Impact of post-discharge phone calls on non-urgent hospital returns < 90 days following primary bariatric surgery. Surg Endosc 2023; 37:1222-1230. [PMID: 36167872 PMCID: PMC9514683 DOI: 10.1007/s00464-022-09647-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 09/13/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Quality of care delivery may improve patient outcomes post-bariatric surgery. We examined the quality of post-discharge phone calls (PhDC) to determine the impact on early (< 90 day) non-urgent hospital returns (NUHR) following primary bariatric surgery. METHODS A retrospective review was performed on patients who underwent Roux-en-Y-gastric bypass (RYGB) or sleeve gastrectomy (SG) in 2019. Patients were compared between presence of care coaching (Jan-June 2019) versus no care coaching (July-Dec 2019). Baseline demographics, comorbidities, psychiatric history, and PhDC were collected. Index PhDCs were coded for completeness using a scoring system and rated by call quality. Patients were stratified into NUHR versus control group (Never returns [NR]). Primary analysis examined the impact of PhDC on NUHR. Sub-analysis examined the impact of call quality. Univariate analysis was performed using Chi-square or Fisher's exact tests. Multivariate analysis (MVA) was used to determine predictors of NUHR. A p-value of ≤ 0.05 was statistically significant. RESULTS A total of 359 patients were included. Compared to the NR group (n = 294), NUHRs (n = 65) were more likely to be younger (41.3 + 12.1 versus 45.0 + 10.8 years, p = 0.024), with baseline anxiety (41.5% versus 23.5%, p = 0.003), and undergo RYGB (73.3% versus 57.8%, p = 0.031). There was a significant difference in number of PhDC in the NUHR and NR groups (p = 0.0206). Care-coached patients had significantly higher rates of high-quality phone calls (p < 0.0001) compared to non-care-coached patients. MVA demonstrated younger age (OR = 0.97, CI: 0.95-1.00; p = 0.023), anxiety (OR = 2.09, CI: 1.17-3.73; p = 0.012), RYGB (OR = 1.88, CI: 1.02-3.45; p = 0.042), and > 50% call quality versus no PhDC (OR = 0.45, CI: 0.25-0.83; p = 0.010) were independently associated with NUHRs. CONCLUSION High-quality PhDCs may play a role in mitigating NUHRs. Care coaching represents a potential intervention to decrease high rates of NUHR in primary bariatric surgery patients.
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Affiliation(s)
- Dahlia M. Kenawy
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH USA
| | - Lindsay M. Breslin
- Department of Research Information Technology, The Ohio State University, Columbus, OH USA
| | - J. C. Chen
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH USA
| | - Muna M. Tamimi
- College of Medicine, The Ohio State University, Columbus, OH USA
| | - Joann K. North
- The Ohio State University Wexner Medical Center, Columbus, OH USA
| | - Mahmoud Abdel-Rasoul
- Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University Wexner Medical Center, Columbus, OH USA
| | - Sabrena F. Noria
- Department of Surgery, Division of General and Gastrointestinal Surgery, The Ohio State University Wexner Medical Center, N718 Doan Hall, 410 W 10th Avenue, Columbus, OH 43210 USA
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Furdock RJ, Feldman B, Sinkler M, Connelly M, Hoffa M, Simpson M, Hendrickson SB, Vallier HA. Factors influencing participation in psychosocial programming among orthopaedic trauma patients with PTSD. Injury 2022; 53:4000-4004. [PMID: 36184361 DOI: 10.1016/j.injury.2022.09.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 09/22/2022] [Accepted: 09/25/2022] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Post Traumatic Stress Disorder (PTSD) commonly occurs following acute trauma. Post-injury outcomes are negatively impacted by PTSD. Trauma Recovery Services (TRS) programming was developed at our institution in 2013 to provide psychosocial programming that increases patient satisfaction with care and ability to return to work and decreases PTSD symptoms. We sought to identify factors that influence patients' decision to participate in programming. METHODS Over a 3-year period at a single, urban level 1 trauma center, 172 patients over the age of 18 screened positive for PTSD on the validated PTSD checklist for DSM-5 (PCL-5) screening tool. Demographic, socioeconomic, injury, and medical comorbidity information was collected. Variables were initially compared in a univariate manner via Chi-squared, Fisher exact, t-test, or Mann-Whitney U, as appropriate. Variables that had a p-value <0.2 on univariate analysis were entered into a backward stepwise logistic regression model to identify independent predictors of participation in TRS programming. RESULTS Mean age was 37.8 years. 70.1% of patients were male. The most common mechanisms of injury were gunshot wound (33.7%), motor vehicle crash (19.0%), and burn. 33.5% of patients participated in TRS programming. Nine predictors had p<.2 on univariate analysis and were entered into the stepwise regression model. Four predictors remained in the final model. Patients with private insurance (RR=2.2, p=.038), high school diploma or greater (RR=1.53, p=.002; Table 1), and PCL-5 score greater than 50 were more likely to participate in TRS programming (RR=1.42, p=.046). Patients who live 20 or more minutes away by car from TRS were less likely to participate in programming (RR=0.47, p=.065). DISCUSSION Patients with more severe PTSD, higher levels of education, and private insurance were more likely to participate in TRS programming. Participation in TRS and similar psychosocial programs may be improved by minimizing the participant's potential commute to the program location.
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Affiliation(s)
- Ryan J Furdock
- Study performed at MetroHealth Medical Center, an affiliate of Case Western Reserve University School of Medicine, USA
| | - Blake Feldman
- Study performed at MetroHealth Medical Center, an affiliate of Case Western Reserve University School of Medicine, USA
| | - Margaret Sinkler
- Study performed at MetroHealth Medical Center, an affiliate of Case Western Reserve University School of Medicine, USA
| | - Madison Connelly
- Study performed at MetroHealth Medical Center, an affiliate of Case Western Reserve University School of Medicine, USA
| | - Matthew Hoffa
- Study performed at MetroHealth Medical Center, an affiliate of Case Western Reserve University School of Medicine, USA
| | - Megen Simpson
- Study performed at MetroHealth Medical Center, an affiliate of Case Western Reserve University School of Medicine, USA
| | - Sarah B Hendrickson
- Study performed at MetroHealth Medical Center, an affiliate of Case Western Reserve University School of Medicine, USA
| | - Heather A Vallier
- Study performed at MetroHealth Medical Center, an affiliate of Case Western Reserve University School of Medicine, USA.
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Cantrell CK, Versteeg GH, Goedderz CJ, Johnson DJ, Tanenbaum JE, Carney JJ, Bigach SD, Williams JC, Stover MD, Butler BA. Risk factors for loss to follow up of pelvis and acetabular fractures. Injury 2022; 53:3800-3804. [PMID: 36055809 DOI: 10.1016/j.injury.2022.08.032] [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: 03/14/2022] [Revised: 07/23/2022] [Accepted: 08/13/2022] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Pelvic and acetabular fracture incidence is increasing worldwide for more than four decades. There is currently no evidence examining risk factors for loss to follow up in patients with these injuries. METHODS Patients presenting with pelvic and/or acetabular fractures at our institution between 2015 and 2020 were included. Demographic, injury, treatment, and follow up information was included. Excluded patients were those who sustained a pathologic fracture, has a course of treatment prior to transfer to our centre, or expired prior to discharge. RESULTS 446 patients, 263 with a pelvic ring injury, 172 with an acetabular fracture, and 11 with combined injuries were identified. 271 (61%) of patients in our cohort followed up in Orthopaedic clinic (p = 0.016). With an odds ratio of 2.134, gunshot wound mechanism of injury was the largest risk factor for loss to follow up (p = 0.031) followed by male sex (OR= 1.859) and surgery with general trauma surgery (OR=1.841). The most protective risk factors for follow up with Orthopaedic surgery were operatively treated pelvic and acetabular fractures (OR=0.239) and Orthopaedic Surgery as the discharging service (OR=0.372). DISCUSSION Numerous risk factors exist for loss to follow up including male sex, ballistic mechanism, and discharging service. Investigation into interventions to improve follow up in these patients are warranted.
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Affiliation(s)
- Colin K Cantrell
- Department of Orthopaedic Surgery, Northwestern Feinberg School of Medicine, 676 N St Clair Ave, Suite 1350, Chicago, IL, 60611, USA.
| | - Gregory H Versteeg
- Department of Orthopaedic Surgery, Northwestern Feinberg School of Medicine, 676 N St Clair Ave, Suite 1350, Chicago, IL, 60611, USA
| | - Cody J Goedderz
- Department of Orthopaedic Surgery, Northwestern Feinberg School of Medicine, 676 N St Clair Ave, Suite 1350, Chicago, IL, 60611, USA
| | - Daniel J Johnson
- Department of Orthopaedic Surgery, Northwestern Feinberg School of Medicine, 676 N St Clair Ave, Suite 1350, Chicago, IL, 60611, USA
| | - Joseph E Tanenbaum
- Department of Orthopaedic Surgery, Northwestern Feinberg School of Medicine, 676 N St Clair Ave, Suite 1350, Chicago, IL, 60611, USA
| | - John J Carney
- Department of Orthopaedic Surgery, Northwestern Feinberg School of Medicine, 676 N St Clair Ave, Suite 1350, Chicago, IL, 60611, USA
| | - Stephen D Bigach
- Department of Orthopaedic Surgery, Northwestern Feinberg School of Medicine, 676 N St Clair Ave, Suite 1350, Chicago, IL, 60611, USA
| | - Joel C Williams
- Department of Orthopaedic Surgery, John H Stroger Hospital of Cook County, 1969 Odgen Ave, Chicago, IL, 60612, USA; Department of Orthopaedic Surgery, Rush University Medical Center, 1620 W Harrison St, Chicago, IL, 60612, USA
| | - Michael D Stover
- Department of Orthopaedic Surgery, Northwestern Feinberg School of Medicine, 676 N St Clair Ave, Suite 1350, Chicago, IL, 60611, USA
| | - Bennet A Butler
- Department of Orthopaedic Surgery, Northwestern Feinberg School of Medicine, 676 N St Clair Ave, Suite 1350, Chicago, IL, 60611, USA; Department of Orthopaedic Surgery, John H Stroger Hospital of Cook County, 1969 Odgen Ave, Chicago, IL, 60612, 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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13
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Wake E, Ranse J, Marshall AP. Scoping review of the literature to ascertain how follow-up care is provided to major trauma patients post discharge from acute care. BMJ Open 2022; 12:e060902. [PMID: 36691199 PMCID: PMC9462116 DOI: 10.1136/bmjopen-2022-060902] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 08/22/2022] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVES Survival following traumatic injury has increased, requiring ongoing patient follow-up. While longitudinal outcomes of trauma patients are reported, little is known about optimal delivery of follow-up service for this group. The aim of this scoping review was to identify and describe the structure, process and outcomes of postdischarge follow-up services for patients who sustained major trauma. EVIDENCE REVIEW This scoping review was conducted by searching CINAHL, MEDLINE and EMBASE databases. Articles were screened by three independent reviewers. The data of selected articles were organised in the categories of the Donabedian quality framework: structure, processes and outcomes. RESULTS Twenty-six articles were included after screening by title/abstract then full text against the inclusion/exclusion criteria; 92% (n=24) were from the USA.Follow-up services were provided by designated trauma centres and delivered by a mixture of health disciplines. Delivery of follow-up was multimodal (in person/telehealth). Protocols and guidelines helped to deliver follow-up care for non-physician led services.Ongoing health issues including missed injuries, pain and infection were identified. No standardised criteria were established to determine recipients, the timing or frequency of follow-up was identified. Patients who engaged with follow-up services were more likely to participate in other health services. Patients reported satisfaction with follow-up care. CONCLUSION There are wide variations in how follow-up services for major trauma patients are provided. Further evaluation should focus on patient, family and organisational outcomes. Identifying who is most likely to benefit, when and how follow-up care is delivered are important next steps in improving outcomes.
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Affiliation(s)
- Elizabeth Wake
- Trauma Service, Gold Coast University Hospital, Southport, Queensland, Australia
- School of Medicine, Griffith University, Southport, Queensland, Australia
| | - Jamie Ranse
- School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Cast Campus, Queensland, Australia
| | - Andrea P Marshall
- Menzies Health Institute Queensland, Griffith University, Gold Cast Campus, Queensland, Australia
- Nursing, Midwifery Education and Research Unit, Gold Coast Hospital and Health Service, Southport, Queensland, Australia
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Sinkler MA, Furdock RJ, Vallier HA. Treating trauma more effectively: A review of psychosocial programming. Injury 2022; 53:1756-1764. [PMID: 35491278 DOI: 10.1016/j.injury.2022.04.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 04/20/2022] [Accepted: 04/21/2022] [Indexed: 02/02/2023]
Abstract
IMPORTANCE Traumatic events are the leading cause of life-altering disability in adults of working age. The management of patients with traumatic injury has substantially improved due to development of sophisticated trauma centers increasing survival after injury. Unlike the adoption of the trauma system framework, the same has not occurred with specialized trauma recovery services to include mental and social health needs. This literature review will discuss unique issues facing trauma survivors, some current recovery programs available, outcomes and benefits of these programs, and barriers that impair widespread incorporation. OBSERVATIONS Studies have shown that patients with traumatic injury experience reduction in quality of life and concurrent threats to mental health, including post-traumatic stress disorder (PTSD), alcohol use disorder, and recreational substance abuse. Patients with traumatic injury also have high recidivism rates, low pain management satisfaction, and poor engagement in care following injury. Screening efforts for PTSD, mental illness, and alcohol and substance abuse are more widely available interventions. Early coordinated efforts included dedicated multidisciplinary recovery teams. Recently, more methodical and organized programs, such as the Trauma Survivors Network, trauma collaborative care, Trauma Recovery Services, and Center of Trauma Survivorship, have been implemented. CONCLUSIONS AND RELEVANCE The enrollment of patients with traumatic injury in novel programs to enhance recovery has led to heightened self-efficacy, better coping mechanisms, and increased use of mental health services. Additionally, trauma recovery services have been shown to reduce recidivism and have generated cost savings for hospital systems. While positive outcomes have been demonstrated, they are not consistently predictable. Barriers for widespread implementation include limitations of time, funding, and institutional support. This article describes models of successful programs initiated within some trauma centers, which may be duplicated to serve future trauma survivors.
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Affiliation(s)
- Margaret A Sinkler
- Department of Orthopaedic Surgery, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Ryan J Furdock
- Department of Orthopaedic Surgery, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Heather A Vallier
- Department of Orthopaedic Surgery, Case Western Reserve University School of Medicine, Cleveland, OH.
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15
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Kumar A, Sinha S, Jameel J, Kumar S. Telemedicine trends in orthopaedics and trauma during the COVID-19 pandemic: A bibliometric analysis and review. J Taibah Univ Med Sci 2021; 17:203-213. [PMID: 34690642 PMCID: PMC8521392 DOI: 10.1016/j.jtumed.2021.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 08/13/2021] [Accepted: 09/03/2021] [Indexed: 12/23/2022] Open
Abstract
Objectives In the wake of recent widespread interest in telemedicine during the COVID-19 era, many orthopaedic surgeons may be unfamiliar with clinical examination skills, patients’ safety, data security, and implementation-related concerns in telemedicine. We present a bibliometric analysis and review of the telemedicine-related publications concerning orthopaedics care during the COVID-19 pandemic. Such analysis can help orthopaedic surgeons become acquainted with the recent developments in telemedicine and its usage in regular orthopaedics practice. Methods We systematically searched the database of Thomson Reuters Web of Science for telemedicine-related articles in orthopaedics published during the COVID-19 pandemic. The selected articles were analysed for their source journals, corresponding authors, investigating institutions, countries of the corresponding authors, number of citations, study types, levels of evidence, and a qualitative review. Results Fifty-nine articles meeting the inclusion criteria were published in 28 journals. Three hundred forty-two authors contributed to these research papers. The United States (US) contributed the most number of articles to the telemedicine-related orthopaedics research during the COVID-19 era. All articles combined had a total of 383 citations and 66.1% were related to the Economic and Decision-making Analyses of telemedicine implementation. By and large, level IV evidence was predominant in our review. Conclusion Telemedicine can satisfactorily cover a major proportion of patients' visits to outpatient departments, thus limiting hospitals’ physical workload. Telemedicine has a potential future role in emergency orthopaedics and inpatient care through virtual aids. The issues related to patient privacy, data security, medicolegal, and reimbursement-related aspects need to be addressed through precise national or regional guidelines. Lastly, the orthopaedic physical examination is a weak link in telemedicine and needs to be strengthened.
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Affiliation(s)
- Arvind Kumar
- Department of Orthopaedics, Hamdard Institute of Medical Sciences and Research, New Delhi, India
| | - Siddhartha Sinha
- Department of Orthopaedics, Hamdard Institute of Medical Sciences and Research, New Delhi, India
| | - Javed Jameel
- Department of Orthopaedics, Hamdard Institute of Medical Sciences and Research, New Delhi, India
| | - Sandeep Kumar
- Department of Orthopaedics, Hamdard Institute of Medical Sciences and Research, New Delhi, India
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Truong EI, DeMario BS, Hendrickson S, Kalina MJ, Vallier HA, Tseng ES, Claridge JA, Ho VP. Factors Influencing Nonadherence to Recommended Postdischarge Follow-Up After Trauma. J Surg Res 2020; 256:143-148. [PMID: 32707396 DOI: 10.1016/j.jss.2020.06.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 05/27/2020] [Accepted: 06/16/2020] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Historically, trauma patients have low adherence to recommended outpatient follow-up plans, which is crucial for improved long-term clinical outcomes. We sought to identify characteristics associated with nonadherence to recommended outpatient follow-up visits. METHODS This is a single-center retrospective examination of inpatient trauma survivors admitted to a level 1 trauma center (March 2017-March 2018). Patients with known alternative follow-up were excluded. All outpatient visits within 1 y from the index admission were identified. The primary outcome was nonadherence, which was noted if a patient failed to follow-up for any specialty recommended in the discharge instructions. Factors for nonadherence studied included age, injury severity score, mechanism, length of stay, number of referrals made, and involvement with a Trauma Recovery Services program. Bivariate and logistic regression analyses were performed. RESULTS A total of498 patients were identified (69% men, median age 43 y [range, 26-58 y], median injury severity score 14 [range, 9-19]). Among them, 240 (47%) were nonadherent. The most common specialties recommended were orthopedic surgery (56% referred, 19% nonadherent), trauma (54% referred, 35% nonadherent), and neurosurgery (127 referred, 35% nonadherent). Lowest levels of follow-up were seen for nonsurgical referrals. In adjusted analysis, a higher number of referrals made (odds ratio [OR], 2.45; 95% confidence interval [CI], 1.95-3.05) and older age (OR, 1.01; 95% CI, 1.00-1.02) were associated with nonadherence. Trauma Recovery Service participants and penetrating trauma patients were more likely to be adherent (OR, 0.60; 95% CI, 0.37-0.97). CONCLUSIONS The largest contributor to nonadherence was the number of referrals made; patients who were referred to multiple specialists were more likely to be nonadherent. Peer support services may lower barriers to follow-up.
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Affiliation(s)
- Evelyn I Truong
- Department of Surgery, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Belinda S DeMario
- Department of Surgery, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Sarah Hendrickson
- MetroHealth Medical Center, Community Trauma Institute, Cleveland, Ohio
| | - Mark J Kalina
- MetroHealth Medical Center, Community Trauma Institute, Cleveland, Ohio
| | - Heather A Vallier
- Department of Orthopedic Surgery, MetroHealth Medical Center, Cleveland, Ohio
| | - Esther S Tseng
- Department of Surgery, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Jeffrey A Claridge
- Department of Surgery, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Vanessa P Ho
- Department of Surgery, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio; Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio.
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