Health-Related Quality of Life and Rehabilitation Cost Following Intensive Care Unit Stay in Multiple Trauma Patients

Stergiannis, Pantelis; Κατσούλας, Θεόδωρος; Fildissis, George; Intas, Georgios; Galanis, Panagiotis; Kosta, Natalia; Zidianakis, Vasilios; Baltopoulos, George

doi:10.1097/jtn.0000000000000042

Cited by 24 publications

(26 citation statements)

References 25 publications

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“…This significant drop and rapid improvement in physical function and more moderate reduction and improvement in mental health is consistent with that reported in some trauma ICU cohorts in other countries (18,48) although there are occasional reports in conflict with this. In a Greek cohort of 85 patients using the EQ-5D severe problems of anxiety were reported in a greater proportion of patients, with more than 60% of patients reporting severe anxiety 6 months after injury, with similar problems in mobility and self-care (46). Follow-up interviews in this Greek study were all conducted in person and this may have influenced the higher levels of compromise in comparison to the current study where self-report was used, although previous examination of the effect of data collection method has found clinical interview resulted in less compromised, rather than more compromised, quality of life results when compared to selfreport (49).…”

Section: Discussionmentioning

confidence: 99%

Physical Function and Mental Health in Trauma Intensive Care Patients

Aitken

Macfarlane

Chaboyer

et al. 2016

Critical Care Medicine

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Section: Discussionmentioning

confidence: 99%

Physical Function and Mental Health in Trauma Intensive Care Patients

Aitken

Macfarlane

Chaboyer

et al. 2016

Critical Care Medicine

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“…7(p822) Patients' ability to use rehabilitation is an important predictor of long-term outcomes of care. [2][3][4]7 Nevertheless, despite its known benefits, rehabilitation may not be available to all patients. 8,9 Studies have demonstrated strong associations between insurance coverage and rehabilitation use 8,[10][11][12] as well as between a lack of insurance and fatal outcomes, including in-hospital mortality [13][14][15] and failure to rescue (FTR).…”

mentioning

confidence: 99%

Implications of the Patient Protection and Affordable Care Act on Insurance Coverage and Rehabilitation Use Among Young Adult Trauma Patients

et al. 2016

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IMPORTANCE Trauma is the leading cause of death and disability among young adults, who are also among the most likely to be uninsured. Efforts to increase insurance coverage, including passage of the Patient Protection and Affordable Care Act (ACA), were intended to improve access to care and promote improvements in outcomes. However, despite reported gains in coverage, the ACA's success in promoting use of high-quality care and enacting changes in clinical end points remains unclear. OBJECTIVES To assess for observed changes in insurance coverage and rehabilitation use among young adult trauma patients associated with the ACA, including the Dependent Coverage Provision (DCP) and Medicaid expansion/open enrollment, and to consider possible insurance and rehabilitation differences between DCP-eligible vs-ineligible patients and among stratified demographic and community subgroups. DESIGN, SETTING, AND PARTICIPANTS A longitudinal assessment of DCP implementation and Medicaid expansion/open enrollment using risk-adjusted before-and-after, difference-indifference, and interrupted time-series analyses was conducted. Eleven years (January 1, 2005, to September 31, 2015) of Maryland Health Services Cost Review Commission data, representing complete patient records from all payers within the state, were used to identify all hospitalized young adult (aged 18-34 years) trauma patients in Maryland during the study period. RESULTS Of the 69 507 hospitalized patients included, 50 548 (72.7%) were male, and the mean (SD) age was 25 (5) years. Before implementation of the DCP, 1 of 4 patients was uninsured. After ACA implementation, the number fell to less than 1 of 10, with similar patterns emerging in emergency department and outpatient settings. The change was primarily driven by Medicaid expansion/open enrollment, which corresponded to a 20.1 percentage-point increase in Medicaid (95% CI, 18.9-21.3) and an 18.2 percentage-point decrease in uninsured (95% CI, −19.3 to −17.2). No changes were detected among privately insured patients. Rehabilitation use increased by 5.4 percentage points (95% CI, 4.5-6.2)-a 60% relative increase from a baseline of 9%. Mortality (−0.5; 95% CI, −0.9 to −0.1) and failure-to-rescue rates (−4.5; 95% CI, −7.4 to −1.6) also significantly declined. Stratified changes point to significant differences in the percentage of uninsured patients and rehabilitation access across the board, mitigating or even eradicating disparities in certain cases. CONCLUSIONS AND RELEVANCE For patients who are injured, young, and uninsured, Medicaid expansion/open enrollment in Maryland changed insurance coverage and altered patient outcomes in ways that the DCP alone was never intended to do. Implementation of Medicaid expansion/open enrollment transformed the landscape of trauma coverage, directly affecting the health of one of the country's most vulnerable at-risk groups.

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“…Assessment of the functional status of polytrauma patients is particularly challenging due to the large range of types and severity of injuries. The functional status of trauma survivors has been inferred in health-related quality of life (HRQOL) studies in this population, as in studies conducted in Spain 17 ) and Greece 18 ) . At three months post injury, severe trauma victims show drastically reduced functionality and HRQOL 5 ) .…”

Section: Introductionmentioning

confidence: 99%

“…At six months, trauma victims still show a deteriorated HRQOL; although improvement may be observed at 12 months, complete recovery of previous condition is not obtained 17 ) . For injured victims of motor vehicle crashes, serious problems in terms of HRQOL gradually improve during the 2 years after hospital discharge 18 ) .…”

Section: Introductionmentioning

confidence: 99%

Recovery of functional capacity in severe trauma victims at one year after injury: association with trauma-related and hospital stay aspects

et al. 2016

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[Purpose] The aim of this study was to investigate the functional capacity of trauma survivors one year after hospital discharge and to identify associations with trauma- and hospital stay-related aspects in a developing country. [Subjects and Methods] This study included severe trauma patients (Injury Severity Score ≥16; ≥18 years old) who were admitted to an intensive care unit in Sao Paulo, Brazil. Hospital stay data were collected from the patients’ records. Functional capacity was assessed using the Glasgow Outcome Scale and Lawton Instrumental Activities of Daily Living Scale one year after hospital discharge. Patients were asked if they had returned to work/school. [Results] Forty-nine patients completed follow-up. According to the Glasgow Outcome Scale data, most patients had moderate or mild/no dysfunction. The Lawton Instrumental Activities of Daily Living Scale showed that 60–70% of the subjects performed most activities independently. Multiple linear regression of the Glasgow score, Acute Physiology and Chronic Health Disease Classification System II score, length of mechanical ventilation, and hospital length of stay revealed an association between the Lawton Instrumental Activities of Daily Living Scale and hospital length of stay. Overall, 32.6% of the subjects had returned to work/school. [Conclusion] Most severe trauma patients experienced functional recovery, although only one-third had returned to work/school one year after hospital discharge. Hospital length of stay was identified as a significant predictor of functional recovery.

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Health-Related Quality of Life and Rehabilitation Cost Following Intensive Care Unit Stay in Multiple Trauma Patients

Cited by 24 publications

References 25 publications

Physical Function and Mental Health in Trauma Intensive Care Patients

Physical Function and Mental Health in Trauma Intensive Care Patients

Implications of the Patient Protection and Affordable Care Act on Insurance Coverage and Rehabilitation Use Among Young Adult Trauma Patients

Recovery of functional capacity in severe trauma victims at one year after injury: association with trauma-related and hospital stay aspects

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