title: An expanded delivery model for outpatient burn rehabilitation.
abstract: Despite the numerous multidisciplinary services burn centers provide, a number of challenges to obtaining optimal outcomes exist. The goal of this study was to overcome the barriers to effective burn rehabilitation by utilizing an expanded care coordinator (ECC) to supplement the existing outpatient services. In this between-group, single-blind, randomized, controlled trial, the control group (n = 41) received standard outpatient care and the experimental group (n = 40) received additional services provided by the ECC, including telephone calls at set intervals (24 hours postdischarge, 2, 4, 8, 12 weeks postdischarge and 5, 7, 9 months postdischarge). The ECC was trained in motivational interviewing, crisis intervention, and solution-focused counseling. He assisted patients before and after each clinic visit, coordinated outpatient services in their geographic area (physical and occupational therapy, counseling, primary care provider referrals, etc.), and helped develop problem-solving approaches to accomplish individualized goals. Outcome measures included patient identified goals utilizing the goal attainment scale, the urn-specific health scale-brief, the Short Form 12, a patient satisfaction survey, and a return to work survey. The average subject age was 43 years (SD = 16.9) with a mean TBSA of 19% (SD = 18.8). The average length of hospitalization was 36 days (SD = 42.9). The patient and injury characteristics were similar between the study groups. For the experimental group, 33% completed seven calls, with 23% completing all the eight calls. All were assessed using general linear models and were adjusted for sex, age, length of hospitalization, urban vs rural area of residence, %TBSA burn, and ethnicity. There was no difference between the control and experimental groups for any of the outcome measures at either 6 or 12 months postburn. No differences in outcomes between the groups were found. All participants appreciated the individualized goal setting process that was used as an outcome measure and this may have accounted for the similar outcomes in both the groups. (The measure may have been more of an intervention, thus contributing to the strength of the control group.) Although most patients with burn injuries may not need an intervention that is this intensive, a subset of patients at higher risk or with more severe injuries may benefit from more intensive and personalized services. Future research should examine the benefits of individual goal setting processes for all the patients and also attempt to identify those patients most at risk for poorer outcomes and therefore, likely to benefit of more intensive personalized services.
authors.affiliation: From the Departments of *Rehabilitation Medicine and †Surgery, Harborview Medical Center, University of Washington School of Medicine, Seattle; and ‡Department of Biostatistics and Informatics, University of Colorado Health Sciences Center, Denver.
authors.forename: Shelley A
authors.initials: SA
authors.lastname: Wiechman
authors.forename: Gretchen J
authors.initials: GJ
authors.lastname: Carrougher
authors.forename: Peter C
authors.initials: PC
authors.lastname: Esselman
authors.forename: Matthew B
authors.initials: MB
authors.lastname: Klein
authors.forename: Erin M
authors.initials: EM
authors.lastname: Martinez
authors.forename: Loren H
authors.initials: LH
authors.lastname: Engrav
authors.forename: Nicole S
authors.initials: NS
authors.lastname: Gibran
mesh_terms: D000328:Adult; D000553:Ambulatory Care / Q000458:organization & administration*; D002056:Burns / Q000523:psychology / Q000534:rehabilitation*; D003419:Crisis Intervention; D003695:Delivery of Health Care / Q000458:organization & administration*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D062405:Motivational Interviewing; D017063:Outcome Assessment, Health Care; D010347:Patient Care Planning; D017060:Patient Satisfaction; D016037:Single-Blind Method