Social Determinants of Health and Patients With Traumatic Injuries: Is There a Relationship Between Social Health and Orthopaedic Trauma?

Abstract

BackgroundAlthough economic stability, social context, and healthcare access are well-known social determinants of health associated with more challenging recovery after traumatic injury, little is known about how these factors differ by mechanism of injury. Our team sought to use the results of social determinants of health screenings to better understand the population that engaged with psychosocial support services after traumatic musculoskeletal injury and fill a gap in our understanding of patient-reported social health needs.Question/purposeWhat is the relationship between social determinants of health and traumatic musculoskeletal injury?MethodsTrauma recovery services is a psychosocial support program at our institution that offers patients and their family members resources such as professional coaching, peer mentorship, post-traumatic stress disorder screening and treatment, educational resources, and more. This team engages with any patient admitted to, treated at, and released from our institution. Their primary engagement population is individuals with traumatic injury, although not exclusively. Between January 2019 and October 2021, the trauma recovery services team interacted with 6036 patients. Of those who engaged with this service, we considered only patients who experienced a traumatic musculoskeletal injury and had a completed social determinants of health screening tool. During the stated timeframe, 13% (814 of 6036) of patients engaged with trauma recovery services and had a complete social determinants of health screening tool. Of these, 53% (428 of 814) had no physical injury. A further 26% (99 of 386) were excluded because they did not have traumatic musculoskeletal injuries, leaving 4.8% (287) for analysis in this cross-sectional study. The study population included patients who interacted with trauma recovery services at our institution after a traumatic orthopaedic injury that occurred between January 2019 and October 2021. Social determinants of health risk screening questionnaires were self-administered prospectively using a screening tool developed by our institution based on Centers for Medicare and Medicaid Services social determinants of health screening questions. Mechanisms of injury were separated into intentional (physical assault, sexual assault, gunshot wound, or stabbing) and unintentional (fall, motor vehicle collision, or motorcycle crash). During the study period, 287 adult patients interacted with trauma recovery services after a traumatic musculoskeletal injury and had complete social determinant of health screening; 123 injuries were unintentional and 164 were intentional. Patients were primarily women (55% [159 of 287]), single (73% [209 of 287]), and insured by Medicaid or Medicare (78% [225 of 287]). Mechanism category was determined after a thorough medical record review to verify the appropriate category. An initial exploratory univariate analysis was completed for the primary outcome variable using the Pearson chi-squared test for categorical variables a...

CORR Insights®: Social Determinants of Health and Patients With Traumatic Injuries: Is There a Relationship Between Social Health and Orthopaedic Trauma?

“…An encouraging aspect of this month’s paper by Breslin et al [4] is their description of the work done by Trauma Recovery Services to identify and meet SDOH needs. Several other institutions have implemented similar programs.…”

“…Most of the orthopaedic research involving SDOH and health disparities focuses on access to care and outcomes data rather than examining injury patterns. In this issue of Clinical Orthopaedics and Related Research ®, Breslin et al [4] sought to describe a relationship between underlying SDOHs and traumatic musculoskeletal injury. Their institution, Case Western Reserve University, is home to Trauma Recovery Services, a psychosocial support program for patients admitted with traumatic injuries.…”

“…Most of the orthopaedic research involving SDOH and health disparities focuses on access to care and outcomes data rather than examining injury patterns. In this issue of Clinical Orthopaedics and Related Research ® , Breslin et al [4] Where Do We Need To Go?…”

Optimizing recovery after trauma: overview of existing literature and practices

“…[11][12][13][14][15][16][17] It has further been shown that individuals with adverse social circumstances and underlying mental illness are at elevated risk for protracted and poor recovery. [17][18][19][20] The reasons for this are numerous, including limited access to relevant services due to insufficient income or insurance. 14,21 Most hospital systems, even in developed countries, lack routine access to screening and treatment for mental and social health needs.…”

“…A growing body of literature has demonstrated that assessment and management of mental health and social circumstances are essential to optimizing recovery. 17,18,[22][23][24][25] Programmes and measures in this space have not been standard of care, but have shown promise in improving patient engagement and mitigating early complications, readmissions, and trauma recidivism. 24,[26][27][28][29][30] This review will highlight the importance of mental health and social support programming in optimizing outcomes after acute traumatic injury.…”