637 Disparities in Discharge Disposition: A Burn Model Systems National Database Study

Abstract

Abstract Introduction Previous data suggest that disparities exist in access to inpatient rehabilitation following burn injury. We aimed to characterize the association between patient race/ethnicity and discharge disposition across multiple centers. Methods Data were derived from the prospectively maintained Burn Model Systems national database. All participants admitted to one of five participating centers between 1994 and 2019, who survived to discharge with a known disposition, were included. The relationship between patient characteristics, injury factors and discharge to home, a skilled nursing facility (SNF), or inpatient rehabilitation was modeled using multinomial generalized estimating equations. Pre-specified stratified analyses were conducted to examine effect modification. Results We identified 4395 participants who met inclusion criteria. Participants were 74% White non-Hispanic (n=3269), 18% Black non-Hispanic (n=812), 3% Hispanic (n=122), 0.5% Asian (n=24), and 4% Other (n=168). Most were aged 18–64 years (68%, n=2998). Overall, 79% (n=3585) of participants were discharged home, 12% to inpatient rehabilitation (n=534), and 6% to SNF (n=276). After adjustment for patient characteristics and injury factors, there were no differences in discharge destination by race/ethnicity. However, subgroup analyses demonstrated effect modification by both center and burn size. At 2 centers, Black participants were significantly more likely to be discharged to SNF or inpatient rehabilitation (Center 1 OR 1.98, 95% CI 1.02–3.85; Center 2 OR 2.36, 95% CI 1.07–5.19). Similarly, among all participants with >20% TBSA, Black participants were more likely to be discharged to SNF or inpatient rehabilitation (OR 1.38, 95% CI 1.06–1.81). Across all groups, having insurance was associated with discharge to SNF or inpatient rehabilitation (OR 1.68, 95% CI 1.21–2.33). Conclusions Although no overall difference in discharge destination by race was identified, stratified analyses indicate disparities in discharge disposition at the patient and system level. At specific centers, and among those with >20% TBSA injury, Black participants are more likely to be discharged to SNF and inpatient rehabilitation than other ethnic groups. Applicability of Research to Practice Both patient and system level factors are associated with discharge to higher levels of post-discharge care, suggesting that further characterization of these factors is warranted. Such data can inform interventions and policy changes aimed at ensuring equitable access to appropriate post-discharge care.