J. Kelm1, I. Mekled1, J. Monahan1, E. J. Oh1, M. R. Hemmila1, J. W. Scott1 1University Of Michigan, Department Of Surgery, Ann Arbor, MI, USA
Introduction:
Traumatic injury has been described as a moment of injury with a lifetime of impact. Trauma survivors are at high risk of losing their jobs and experiencing high, unplanned medical bills which may result in financial toxicity—defined as the harmful effects of illness, injury, and subsequent medical care. While there is growing interest in measuring long-term patient-reported physical and mental health outcomes among trauma survivors, little is known regarding patient-reported measures of financial toxicity.
Methods:
We surveyed adult trauma survivors from five level 1 or level 2 trauma centers across the state within 1 year of their injury. Respondents were contacted by telephone calls, text messages, or emails as a part of a statewide quality collaborative and invited to complete an online electronic survey. Survey responses were then linked to a statewide trauma registry that includes registrar-abstracted clinical data in accordance with the national trauma data standard. Financial outcomes of interest from the survey included the following five domains of financial toxicity: (i) medical debt or inability to pay medical bills, (ii) difficulty with non-medical debt or bills, (iii) delayed or forgone medical care due to costs, (iv) job loss, and (v) income loss.
Results:
We identified 111 survey respondents with a median follow-up time of 5.5 months (IQR: 3.8-8.3 months). Respondents had a median age of 63 years (IQR: 43-75), 51.4% were female, 96.4% were white, and 37.8% (n=42) were working at the time of injury. Insurance coverage was: 41.4% Medicare, 33.3% Private/Commercial, 21.6% Workers Compensation or No-Fault Auto Insurance, 1.8% Medicaid, and 1.8% Uninsured. Median injury severity score was 10 (IQR: 5-14) and median length of hospital stay was 5 days (IQR: 2-7). 45.1% of all respondents had positive responses for at least 1 of 5 measures of financial toxicity (Table). On logistic regression analyses, financial toxicity was significantly associated with insurance coverage type, but it was not significantly associated with injury severity score.
Conclusion:
Nearly half of all trauma survivors reported one or more measures of financial toxicity while recovering from injury. For trauma survivors, financial strain arises from both problems with debt and bills (two-in-four respondents) as well as job or income loss (one-in-three respondents). Consequently, nearly one-in-five delayed or forwent needed medical care due to costs. Strategies to mitigate financial toxicity after injury are urgently needed to optimize recovery for trauma survivors.
