S. Chun Fat1, J. P. Herrera-Escobar1, S. S. Al Rafai1, Z. Hashmi1, M. Villanyi2, J. Nabi1, C. Velmahos3, K. Brasel4, G. Kasotakis2, A. Salim1, A. H. Haider1, D. Nehra1 1Brigham And Women’s Hospital,Boston, MA, USA 2Boston University,Boston, MA, USA 3Massachusetts General Hospital,Boston, MA, USA 4Oregon Health And Science University,Portland, OR, USA
Introduction: Previous studies have shown that minority patients have worse in-hospital outcomes than white/Caucasian (WC) patients after trauma. However, very little is known about racial differences in utilization of post-discharge healthcare services after trauma. The purpose of this study is to determine if there is a difference in utilization of healthcare resources between black/African American (BAA) and WC trauma patients after discharge from the hospital.
Methods: Adult trauma patients with an Injury Severity Score (ISS) ≥9 were identified using the institutional trauma registry of three Level I trauma centers and contacted 6- or 12-months post-injury to participate in a telephone interview. Participants were asked about 1) utilization of post-discharge services (inpatient and outpatient rehabilitation, physical/occupational therapy and speech/language therapy), 2) emergency department (ED) visit and 3) outpatient visits for injury related issues. Univariate analyses were performed using chi-squared test. To address for potential confounding, coarsened exact matching (CEM) algorithm was used to match WC and BAA patients on age, sex and Injury Severity Score (ISS). Conditional logistic regression was then used to compare WC versus BAA patients in terms of post-discharge healthcare utilization.
Results: A total of 694 patients were followed. This included 128 BAA patients who were then matched to 566 WC patients. The mean age was 64 years (SD: 20.4) for WC and 44 years (SD: 19.6) for BAA. Mean ISS was not significantly different between groups (14 for WC vs 15 for BAA, p=0.142). Unadjusted analyses revealed that compared to WC patients, BAA patients were less likely to use post-discharge services (80% vs 63% p: <0.001) and had fewer injury-related outpatient visits (42% vs 33% p: 0.054) after discharge. Furthermore, BAA patients were more likely to visit the emergency department for injury-related issues compared to WC (15% vs 8% p: 0.023). After coarsened exact matching, we found significant differences in utilization of healthcare resources post-discharge between the two racial groups (Figure).
Conclusion: This study demonstrates the existence of racial disparities in post-discharge healthcare utilization after trauma for otherwise similarly injured, matched patients. This may partially explain previously reported discrepancies in long-term patient reported outcomes between WC and BAA patients. Interventions aimed at ensuring equitable access to post discharge resources are needed.
