title: Variation in Inpatient Rehabilitation Utilization After Hospitalization for Burn Injury in the United States.
abstract: Approximately 45,000 individuals are hospitalized annually for burn treatment. Rehabilitation after hospitalization can offer a significant improvement in functional outcomes. Very little is known nationally about rehabilitation for burns, and practices may vary substantially depending on the region based on observed Medicare post-hospitalization spending amounts. This study was designed to measure variation in rehabilitation utilization by state of hospitalization for patients hospitalized with burn injury. This retrospective cohort study used nationally collected data over a 10-year period (2001 to 2010), from the Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases (SIDs). Patients hospitalized for burn injury (n = 57,968) were identified by ICD-9-CM codes and were examined to see specifically if they were discharged immediately to inpatient rehabilitation after hospitalization (primary endpoint). Both unadjusted and adjusted likelihoods were calculated for each state taking into account the effects of age, insurance status, hospitalization at a burn center, and extent of burn injury by TBSA. The relative risk of discharge to inpatient rehabilitation varied by as much as 6-fold among different states. Higher TBSA, having health insurance, higher age, and burn center hospitalization all increased the likelihood of discharge to inpatient rehabilitation following acute care hospitalization. There was significant variation between states in inpatient rehabilitation utilization after adjusting for variables known to affect each outcome. Future efforts should be focused on identifying the cause of this state-to-state variation, its relationship to patient outcome, and standardizing treatment across the United States.
authors.affiliation: From the *Department of Anesthesiology and Pediatrics, Duke University School of Medicine, Durham, North Carolina; †Department of Surgery, School of Medicine, University of Washington, Seattle; ‡Department of Rehabilitation Medicine, School of Medicine, University of Washington, Seattle; and §Department of Pediatrics, School of Medicine, University of Washington, Seattle.
authors.forename: Nathaniel H
authors.initials: NH
authors.lastname: Greene
authors.forename: Tam N
authors.initials: TN
authors.lastname: Pham
authors.forename: Peter C
authors.initials: PC
authors.lastname: Esselman
authors.forename: Frederick P
authors.initials: FP
authors.lastname: Rivara
mesh_terms: D000368:Aged; D002053:Burn Units / Q000458:organization & administration; D002056:Burns / Q000175:diagnosis / Q000534:rehabilitation*; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D015601:Injury Severity Score; D007297:Inpatients / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000191:economics*; D016015:Logistic Models; D008297:Male; D006278:Medicare / Q000191:economics; D008875:Middle Aged; D015999:Multivariate Analysis; D016012:Poisson Distribution; D012047:Rehabilitation Centers / Q000191:economics / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome; D014481:United States