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  • Study Reveals Racial Disparities in Postdischarge Rehab After Traumatic Injury

    The road to recovery after a moderate-to-severe traumatic injury can be daunting for anyone, but a new study suggests that individuals who are African American may face an even more challenging path. Researchers found that in groups matched for age, injury type, and injury severity, African Americans were on average 36% less likely to use rehabilitation services and 40% less likely to have outpatient visits postdischarge.

    The presence of the apparent difference echoes APTA's characterization of racial and ethnic disparities as existing "across a range of illnesses and health care services."

    The study's conclusions are based on an analysis of 2.5 years' worth of patient-reported data linked to trauma treatment records from 3 Boston-area level 1 trauma centers participating in the Functional Outcomes and Recovery after Trauma (FORTE) project. Patients included in the study experienced moderate-to-severe trauma, defined as an Injury Severity Score (ISS) of 9 or greater, and participated in phone interviews conducted 6 to 12 months after trauma center discharge. Results were published in the American Journal of Surgery (abstract only available for free).

    Researchers were interested in patient answers to 2 primary questions: whether they received any rehabilitation services by way of discharge to a rehabilitation facility or skilled nursing facility, or through home or outpatient services such as physical therapy; and whether they received injury-related outpatient follow-up in a clinic setting. Participants also were asked about use of emergency departments (EDs) for an injury-related problem.

    The findings: of 1,299 patients studied, 79.8% of Caucasian patients reported receiving rehabilitation services, compared with 64.3% of patients who were African American. Injury-related outpatient clinic visits were reported at a rate of 47% for Caucasians and 40% for African Americans. Injury-related ED visits were reported by 10.1% of Caucasians, compared with 18.7% of African Americans.

    Researchers further analyzed the data by using a "Coarsened Exact Matching" algorithm to create groups of Caucasians and African Americans that were comparable in terms of injury type and severity as well as age and gender. That process reflected similarly significant differences in rehabilitation and outpatient visits but did not show a difference related to use of the ED.

    Other differences in the patient populations also emerged in the study. Caucasian patients tended to be older, with a mean age of 65 compared with a mean age of 45 for African Americans; additionally the Caucasian population reported a move even gender distribution (51% male) compared with the African-American group (67% male). Initially, researchers found differences in the discharge dispositions (home versus rehab facilities) among the groups, but those differences disappeared after adjusting for demographic and injury-related variables. Almost all participants had health insurance.

    "Our results suggest that racial disparities exist in the post-discharge utilization of health care services, which we know affect long term functional outcomes after injury," the authors write, noting that while discharge dispensation may not differ between the groups, patients reporting as African American were less likely to actually receive the rehabilitation services. "These racial discrepancies in post-discharge health services utilization may contribute to worse long-term trauma outcomes," they add.

    The study's authors believe there are "likely many factors" that play a role in these differences, but they speculate that "unconscious provider bias, patient understanding, miscommunication, access to care, and evidence of mistrust toward medical providers" are among the elements at work. Pinpointing the causes, they argue, "may provide insight into avenues for equalizing long-term outcomes for traumatically injured patients."

    Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.