Variation in Inpatient Rehabilitation Utilization After Hospitalization for Burn Injury in the United States.

Approximately 45,000 individuals are hospitalized annually for burn treatment. Rehabilitation after hospitalization can offer a significant improvement in functional outcomes. Very little is known nationally about rehabilitation for burns, and practices may vary substantially depending on the region based on observed Medicare post-hospitalization spending amounts. This study was designed to measure variation in rehabilitation utilization by state of hospitalization for patients hospitalized with burn injury. This retrospective cohort study used nationally collected data over a 10-year period (2001 to 2010), from the Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases (SIDs). Patients hospitalized for burn injury (n = 57,968) were identified by ICD-9-CM codes and were examined to see specifically if they were discharged immediately to inpatient rehabilitation after hospitalization (primary endpoint). Both unadjusted and adjusted likelihoods were calculated for each state taking into account the effects of age, insurance status, hospitalization at a burn center, and extent of burn injury by TBSA. The relative risk of discharge to inpatient rehabilitation varied by as much as 6-fold among different states. Higher TBSA, having health insurance, higher age, and burn center hospitalization all increased the likelihood of discharge to inpatient rehabilitation following acute care hospitalization. There was significant variation between states in inpatient rehabilitation utilization after adjusting for variables known to affect each outcome. Future efforts should be focused on identifying the cause of this state-to-state variation, its relationship to patient outcome, and standardizing treatment across the United States.

Aerial view of the Chapman College campus, Orange, California, 1973

Aerial view of the Chapman College campus, Orange, California, February 23, 1973. Looking north; athletic field and stadium in center. Photographed by "Aerial Eye Inc. - Custom Aerial Photography - 1330 Bristol S. E. #103 - Santa Ana, California 92707." [#9]

Aerial view of the Chapman College campus, Orange, California, 1973

Aerial view of the Chapman College campus, Orange, California, February 23, 1973. North at left; athletic field and stadium in center. Photographed by "Aerial Eye Inc. - Custom Aerial Photography - 13

Aerial view of the Chapman College campus, Orange, California, 1973

Aerial view of the Chapman College campus, Orange, California, January, 1973. North at left; athletic field and stadium in center. Photographed by "Aerial Eye Inc. - Custom Aerial Photography - 1330 Palisades #92 - Santa Ana, California 92707." [#1]

Aerial view of the Chapman College campus, Orange, California

Aerial view of the Chapman College campus, Orange, California, looking east. Memorial Hall is in the center, facing lawn and North Glassell Street.

Chapman College Founders Day Banquet, Anaheim, California, 1968

Chapman College Founders Day Banquet, Anaheim Convention Center, Anaheim, California, 1968. Left to right: Myron Cole, Mrs. C. C. Chapman, and Arlene Reasnor Sayres [author of Chapman Remembers].

Chapman College Child Study Center

Garage and play area at the Chapman College Child Study Center, Orange, California.

Chapman College Child Study Center

Chapman College Child Study Center, North Center Street, Orange, California, June, 1990.

Chapman College Child Study Center

Renovation work on the Chapman College Child Study Center, Orange, California, ca. 1990.

Chapman College Child Study Center

Renovation work on the Chapman College Child Study Center, Orange, California, ca. 1990.

Chapman College Child Study Center play area

Playground area for the Chapman College Child Study Center, Orange, California, June, 1990.

Chapman College Child Study Center

Renovation work on the Chapman College Child Study Center building, Orange, California, 1990.

Architectural rendering of Davis Apartments, Chapman College, Orange, California

Davis Community Center and Apartments opened September, 1974 at 625 North Grand Street, Orange, California, named in honor of Chapman College's fourth president, Dr. John L. Davis. The five two-story apartment buildings were designed by Harold Gimeno & Associates of Santa Ana and built by the J. Ray Construction Company, Inc. of Costa Mesa.

Davis Community Center and Apartments, Chapman College, Orange, Calfornia

Davis Community Center and Apartments opened September, 1974, at 625 North Grand Street, Orange, California, named in honor of Chapman College's fourth president, Dr. John L. Davis. The five two-story apartment buildings were designed by Harold Gimeno & Associates of Santa Ana and built by the J. Ray Construction Company, Inc. of Costa Mesa.