Disparities in Rehab Placement for Victims of Violence
Ella Cornell BA1, Megan Janeway MD2, Nina Jreige BSc1, Victoria Liang BSc1, Stephanie Talutis MD MPH2, Lisa Allee MSW LICSW2, Sabrina Sanchez MD MPH2, Timothy Munzert MSW LCSW2, Tracey Dechert MD FACS2 1Boston University School of Medicine, Boston, MA, USA 2Boston Medical Center, Boston, MA, USA
Background:
Studies have demonstrated racial and insurance disparities in access to post-hospitalization care. This study examines the independent effect of type of injury- violent versus accidental- on rehab placement.
Methods:
We performed a single-center retrospective study of admitted patients with traumatic injuries at our urban academic medical center during a 4-year period. We reviewed data on the admission, physical therapy and case management evaluations, discharge disposition, and the reasons for rehab rejection. Data was analyzed using multivariable logistic regression.
Results:
2757 patient records were reviewed, and patients with violent injury (VI) (n=681) were compared to those with non-violent injury (NVI) (n=2,076). In an unadjusted comparison, VI were significantly less likely to be placed in acute/inpatient rehab (8.1%) compared to NVI (34.1%) and significantly more likely to be discharged home without services (72.1%) compared to NVI (41.2%). Adjusting for age, Injury Severity Score (ISS), race/ethnicity, and insurance provider, the odds of receiving inpatient or acute rehab services (OR= 0.26, 95%CI [0.19, 0.36], p<0.001) and the odds of going home with services (OR=0.66, 95% CI [0.47, 0.94], p=0.022) were significantly lower for VI. VI were inappropriately placed in 10.8% had delayed placement in 16.2% of admissions. Evaluation of case management notes eluded to the reason for delay and rejection being "safety concerns" and requirements for detective statements.
Conclusion:
Violent mechanism of injury is associated with increased likelihood of inappropriate post-hospitalization disposition. Efforts should be made to ensure victims of violence are not discriminated against during the rehab screening process.
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