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Citation
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Prater L, Bulger E, Maier RV, Goldstein E, Thomas P, Russo J, Wang J, Engstrom A, Abu K, Whiteside L, Knutzen T, Iles-Shih M, Heagerty P, Zatzick D. Ann. Surg. 2023; ePub(ePub): ePub. |
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Abstract
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OBJECTIVE: The American College of Surgeons Committee on Trauma (ACS/COT) now requires that trauma centers have in place protocols to identify and refer patients at high risk for the psychological sequelae of traumatic injury. No investigations have documented reductions in utilization and associated potential cost savings associated with trauma center mental health interventions.
SUMMARY BACKGROUND DATA: The investigation was a randomized clinical trial analysis that incorporated novel 5-year emergency department/inpatient health service utilization follow-up data.
METHODS: Patients were randomized to a mental health intervention, targeting the psychological sequalae of traumatic injury (n= 85) versus enhanced usual care control (n= 86) conditions. The intervention included case management that coordinated trauma center-to-community care linkages, psychotropic medication consultation, and psychotherapy elements. Mixed model regression was used to assess intervention and control group utilization differences over time. An economic analysis was also conducted.
RESULTS: Over the course of the 5 years intervention patients demonstrated significant reductions in emergency department/inpatient utilization when compared to control patients (F [19,3210] =2.23, P =0.009]. Intervention utilization reductions were greatest at the 3-6 month (intervention 15.5% versus control 26.7%, Relative Risk [RR]=0.58, 95% Confidence Interval [95% CI] 0.34, 1.00) and 12-15 month (intervention 16.5% versus control 30.6%, RR=0.54, 95% CI 0.32, 0.91) post-injury time points. The economic analysis suggested potential intervention cost savings.
CONCLUSIONS: Mental health intervention is associated with significant reductions in emergency department and inpatient utilization as well as potential cost savings. These findings could be productively integrated into future ACS/COT policy discussions.
Language: en |