Inequity of rehabilitation services after traumatic injury

Ram Nirula, Gina Nirula, Larry M Gentilello
Journal of Trauma 2009, 66 (1): 255-9

BACKGROUND: The delivery of optimal trauma care involves identification and repair of injuries as well as rehabilitation of patients to return them to their preinjury functional status. This requires access to appropriate rehabilitation services; however, such services may be disproportionately allocated to insured individuals leaving lower income individuals without the means to achieve optimal functional status. We hypothesized that a lack of insurance is associated with a reduced likelihood of being transferred to a rehabilitation facility after trauma.

METHODS: A retrospective cohort analysis of blunt National Trauma Databank patients from 2000 to 2004 were assessed to identify predictors of being transferred to a rehabilitation facility at hospital discharge. The likelihood of rehabilitation transfer based on insurance status was assessed, controlling for injury severity, physiology, comorbidities, and patient demographics.

RESULTS: Age, gender, comorbidities, injury, presence of blood alcohol at admission, race, and insurance status were independent predictors of being transferred to a rehabilitation facility among blunt trauma patients (n = 750,468). Patients who were uninsured were 53% (OR = 0.47, 95% CI = 0.41-0.53) less likely to be transferred to a rehabilitation facility upon hospital discharge.

CONCLUSION: Although access to rehabilitation services after injury is a key predictor of recovery from injury, these services are much less available to uninsured patients. This may lead to significant individual and societal emotional and economic burden. The health and economic impacts of this disparity in access to care need to be investigated to determine the personal and societal impact of appropriate resource allocation to rehabilitation for the uninsured.


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