bluuebunny/crossref_metadata_2025_split huggingface dataset:
95 Shifting Payor Mix May Challenge Financial Sustainability of Burn Centers
Authors: Oh Jamie , Sheckter Clifford , Stewart Barclay , Wang Virginia 
Published: May 2023

Abstract

Introduction
The financial sustainability of regional burn centers is essential to the health of the populations they serve, and to the broader development of burn prevention and care innovations. Additionally, per capita out-of-pocket personal health expenditures (OOP) have risen steadily over the last decade. Lower pre-injury income has been shown to predict poorer post-injury quality of life and higher risk of financial toxicity. Given these multi-level dynamics, we aimed to characterize the changing payor landscape and OOP from 2010-2020 at an American Burn Association-verified center to delineate the financial implications of these changes on the health system and per-patient financial liability.

Methods
We merged burn registry and financial data from 2010 to 2020. Financial variables included payor status, pay-to-charge ratio (% of insurance reimbursement/total hospital charges), financial liability (remainder of charges after insurance reimbursement), and patient payment (dollars). Analyses of trend were performed using Pearson’s chi-squared analysis for counts and ANOVA for means.

Results
The percentage of self-pay patients decreased from 2010 to 2020 from over 13% to under 4% of the total number of patients annually (p&lt; 0.001), corresponding with an increase in the percentage of Medicaid patients from 30% to over 40% of the total number of patients annually (p&lt; 0.001). This change became significantly more pronounced in 2014. Notably, most major provisions of the Affordable Care Act were phased in by January 2014, including state-level Medicaid eligibility expansion. Medicaid consistently displayed a lower pay-to-charge ratio (30-40%) than both commercial insurance (~70%) and Medicare (50-80%) across the decade (p&lt; 0.001). Total financial liability increased across the decade for commercial insurance (p&lt; 0.001), Medicaid (p=0.013), and Medicare (p=0.015). From a patient perspective, the average payment burden did not change significantly across the decade despite rising healthcare costs. The average per-patient owed amount ranged from $0-$1000 for self-pay, $150-$200 for Medicare patients, and $500-$600 for patients with commercial insurance.

Conclusions
Burn centers must remain financially sustainable to continue serving their communities. The shifting landscape of healthcare with a population increasingly reliant on Medicaid impacts a hospital’s financial sustainability. This change demonstrates that minor differences in OOP for the average patient may have large implications for hospital systems given the low pay-to-charge ratio of Medicaid.

Applicability of Research to Practice
This work highlights the changing payor landscape and the impact it may have on burn center financial sustainability and risk of patient financial toxicity, particularly among already vulnerable Medicaid recipients.
106 Adipose Derived Stem Cell Paracrine Factor Release in Smokers vs Non Smokers with Burn Injuries
Authors: Deville Paige , Smith Alison , Phelan Herbert , Carter Jeffrey , Warren Olivia , Fontenot Cameron 
Published: May 2023

Abstract

Introduction
Adipose-derived stem cells (ADSCs) have an important role in the modulation of burned tissue repair through the release of paracrine factors that stimulate the wound healing response. In this study, we tested the hypothesis that smoking status alters the profile of paracrine factors secreted from ADSCs isolated from damaged adipose tissue.

Methods
Adipose tissue was collected from adult patients (N=8) with severe burn injuries ( &gt;20% total body surface area) at the index operation. ADSCs were extracted and cultured in vitro. Supernatants were harvested 30 hours after plating and used for cytokine determinations by Multiplex assay. Fluorescence activated single cell sorting (FACS) confirmed their phenotype with markers CD 90, CD 166, and CD 73. Univariate analyses were performed to compare the two cohorts (Smokers vs non smokers). All outliers were removed.

Results
Higher amounts of anti-inflammatory cytokines IL-4(p=0.03) and IL-10(p=0.04) and pro-inflammatory cytokines TNF-alpha (0.03), IL-8, and IFN-gamma (p=0.03) were detected in burn patients who were current everyday smokers when compared to nonsmokers, or former smokers. No significant differences in supernatant concentrations of IL-17, IL-1 beta, TGF-alpha, IL-6, and IL-13 were observed (p &gt;0.05). Mortality was higher in the smoker group when compared to non-smokers (p=0.02).

Conclusions
The results from this study suggest that smoking status in patients with a major burn injury may alter the profile of paracrine factors secreted from ADSCs, and on-going studies will increase sample size and refine experimental approach. Furthermore, these results support the need for studies examining the systemic effects of smoking status of patients suffering burn injuries impacts the wound healing.

Applicability of Research to Practice
Study the effects of smoking on wound healing in burn injuries.
110 Sleep After Discharge: A Cohort Study of Burn Participants in a Home-Based Virtual Rehabilitation Trial
Authors: Rhodes Lori , Sibbett Stephen , Orton Caitlin , Carrougher Gretchen , Stewart Barclay , Bunnell Aaron , Pham Tam 
Published: May 2023

Abstract

Introduction
Patients with major burns experience physiologic changes that can impact their recovery for months after hospital discharge. Little is known about sleep quantity and quality in the post-discharge period. Here, we report on actigraphy sleep data for participants enrolled in a prospective trial of home-based virtual rehabilitation.

Methods
We conducted a randomized controlled trial to evaluate the effect of home-based rehabilitation using Jintronix® modules and Kinect® motion sensor on adherence to therapy. In both intervention and control (usual care) groups, participants were provided a wrist actigraphy accelerometer device (Vivofit®) to wear for the 12-weeks intervention. Sleep data were retrieved remotely and analyzed. Actigraphy data were defined as complete and analyzable if participants had 5 out of 7 days of actigraphy wear and upload in a week. Average weekly sleep was calculated and reported by group assignment. Descriptive statistics were used for comparisons, with p&lt; 0.05 deemed as significant.

Results
Forty-four participants were enrolled with a 1:1 group assignment. Mean age was 38.5 years (SD=14.8), mean TBSA was 15.6% and most were male (68%). Average sleep was well within healthy population norms, with little difference between intervention and controls (7.29 vs.7.20 hours respectively, p=0.25) in the 90 days after discharge. Participants in control group spent more time in light sleep (4.05 vs. 3.88 hours, p&lt; 0.01). The percent deep sleep, however, was comparable to healthy population norms (2.92 and 2.75 respectively, p=0.25). Participants in the control group experienced a higher proportion of nights with sleep disturbances (0.75 vs. 0.70, p=0.006).

Conclusions
Remote wrist wearable-wearable actigraphy data provide an important glimpse into sleep duration and quality for burn injured individuals in the 12 weeks after hospital discharge. An encouraging finding was that total sleep and deep sleep proportion for this cohort were comparable to healthy population norms. Though intervention and control groups were similar in total sleep hours, there were important differences in sleep quality.

Applicability of Research to Practice
Remote data acquisition on post-discharge sleep is feasible.
111 Predictors of Social Participation Outcomes at Two Years after Burn Injury
Authors: Deng Huan , Shepler Lauren J , Tenney Diana , Slavin Mary D , Kazis Lewis , Ryan Colleen , Schneider Jeffrey , Stewart Barclay , Carrougher Gretchen , Kowalske Karen , Wolf Steven , Chacon Kaitlyn Linette 
Published: May 2023

Abstract

Introduction
People with burn injury often experience long-term social participation challenges. A previous study explored demographic and injury variables predicting social participation outcomes after burn injury. This study aims to further examine post-traumatic growth, and physical and psychological symptoms as predictors of social participation.

Methods
This is a multi-center Burn Model System (BMS) study with a prospective cohort design. Adult BMS Database participants from July 2018 to April 2022 were included. Predictors were measured at 12- and 24-month after injury including Post-Traumatic Growth Inventory Short Form (PTGI-SF), Post-Traumatic Stress Disorder Checklist Civilian Version (PCL-C), Patient-Reported Outcomes Measurement Information System (PROMIS-29) Depression, Anxiety, Fatigue, Sleep Disturbance, Pain Interference and Heat Intolerance. Social participation outcomes were measured with Life Impact Burn Recovery Evaluation (LIBRE) Social Interactions and Social Activities at 24-month after injury. Multivariable regression analyses were conducted to assess the association between predictors and outcomes.

Results
A total of 158 burn survivors were included with an average age of 47 years and a mean burn size of 19.5% total body surface area. Significant predictors included PCL-C and PROMIS-29 Depression for LIBRE Social Interactions, and Heat Intolerance, PROMIS-29 Pain Interference and Depression, and PCL-C for LIBRE Social Activities. See Table 1 for details of regression results.

Conclusions
Overall, self-reported post-traumatic stress and depression are associated with limited social interactions while heat intolerance, pain interference, depression, and post-traumatic stress are related to fewer social activities.

Applicability of Research to Practice
This study improves our understanding of the multiple and modifiable factors which influence social participation after burn injury.
113 Impact of State Labor and Industry Benefits on Quality-Adjusted Life-Years Among Working Burn-Injured Adults
Authors: Orton Caitlin , deGrauw Xinyao , Stewart Barclay , Patel Kushang , Carrougher Gretchen , Kowalske Karen , Bamer Alyssa , Hamilton April , Schneider Jeffrey , Ellyson Alice 
Published: May 2023

Abstract

Introduction
State labor and industry benefits (L&I) include workers’ compensation, wage replacement, vocational rehabilitation (VcR), workplace accommodations, job retraining, and labor protections. These vital services are not available to working adults injured outside their workplaces. We aimed to examine the impact of L&I on quality-adjusted life-years (QALY) lost among working adults with burn injury.

Methods
Burn Model System National Database was queried for adult participants who self-identified as worker, volunteer, or caretaker and who answered the Veterans RAND 12-Item Health Survey (VR-12) at discharge (pre-injury recall) and 6-, 12- and 24-month post-injury. Participants were stratified into those with and without L&I and compared using independent samples t-test and Chi-squared test. Primary outcome, QALYs lost, was calculated by transforming VR-12 responses to SF-6D (SF-12) utility values. Mixed effects linear regression modeling was used to assess the impact of L&I on utility values over a 2-year period post-injury. Models were adjusted for age, sex, race, substance use, chronic medical conditions, burn size, hand injury, inhalation injury, and number of surgeries.

Results
495 participants were analyzed (90 with L&I, 405 without L&I). Males accounted for 87% of L&I beneficiaries and 72% of those without L&I (p=0.001). No significant difference was seen in the other covariates. Mean utility values were 0.73 for L&I beneficiaries and 0.73 for those without L&I (p=0.99) pre-injury and were significantly lower for both groups at each timepoint post-injury (Figure 1). Greater utility value loss was seen in those with L&I compared to those without L&I at 6-month (p&lt; =0.07), 12-month (p=0.02), and 24-month (p=0.03). During the 2 years post-injury, L&I beneficiaries lost 0.26 QALY and those without L&I lost 0.18 QALY (p=0.03).

Conclusions
All working adults experienced a drop in utility values post-injury. Those who received L&I benefits lost more QALYs than their non-L&I peers. These findings are consistent with investigations among working adults with non-burn upper extremity and back injuries, suggesting there is opportunity to improve the delivery of L&I benefits and VcR for all injured workers.

Applicability of Research to Practice
Current L&I benefits and VcR services for working adults with burn injury may not meet their needs. To actualize the benefits of VcR service delivery, the intensity of interventions should be more tailored to person-specific needs, risks of complicated return-to-work and recovery journeys.
117 Allocation of Therapist Time: Mobilization of CFU’s in Hand w/Burn Injury
Authors: Fletchall Sandra , Hartl Grace 
Published: May 2023

Abstract

Introduction
Movement of the hands and digits are used to perform communication and activities for IADL’s and competitive employment. Following a second or third degree to the hand(s), there is a potential for the development of burn scar contracture(s) (BSC), which decreases hand skills creating the potential for decreased quality of life.
The ABA data base identifies that 70% of burns are sustained to the upper torso, UE, hands. One ABA verified burn center created a study to identify the time required for the burn therapist to elongate hand CFU’s to pre-burn movement.

Methods
The one-year retrospective study included unilateral and bilateral hand burns with LOS of 2 days or greater or had an outpatient OT session within one week of the burn.
Co-author created the Passive Motion Scoring Grid (PMSG), using a number score with higher number indicating greater passive movement. Education was provided to the OT’s to complete the PMSG at the beginning and end of each hand CFU elongation session. Otherwise, there was no change in the OT burn hand therapy treatment. The study included (5) OT’s with mean of 6 years of experience (3-46).

Results
There were 50 patients, average age was 48.91 years with majority male and African American. All burns were secondary to thermal with burns of 2nd and 3rd degree.
There were 33 unilateral hand burns with an average TBSA of 7.02% and 17 patients sustained bilateral hand burns with an average TBSA of 21.3%.
Unilateral hand burns had an average number of CFU’s of 39.4 (11-68) and hand CFU’s accounted for 87.1% of the CFU’s. Average number of CFU’s in bilateral hand burns was 90.3 (8-196) with hand CFU’s accounting of 83.4% of the CFU’s.
A total of 539 OT sessions were provided to those with unilateral hand burns with an average of 18 OT sessions (3-36). Bilateral hand burns received a total of 487 OT sessions with average of 24.4 OT sessions (4-67)
Therapist time for hand CFU elongation to pre-burn status: unilateral hand burns, 43.5 minutes (SD=24.7) and bilateral hand burns was 53.5 minutes (SD=32.2). The minutes only reflect CFU elongation not the entire therapy time.

Conclusions
Hand burns result in a small number for TBSA, however it results in a greater number of CFU’s than other body locati8ons. The greater number of CFU’s involved, indicates greater potential for development of BSC. At the completion of the burn OT therapy, no patient exhibited BSC.
Providing education and information to funding sources regarding CFU’s in hand burns, equating that to potential BSC development and time required for therapist direct hands-on techniques to obtain pre-burn movement can positively influence authorization for therapy.

Applicability of Research to Practice
Can assist with allocating therapist time with hand burns. Can positively influence funding authorization for therapy.
121 An Examination of Function at Follow-Up in Historically Marginalized Persons with Burn Injury
Authors: Ferreira Betsey , Benavides Lynne , Yelvington Miranda , Lundquist Kathryn , Shepler Lauren J , Schneider Jeffrey , Solis Kyra Jeanine , Mandell Samuel , Gibran Nicole , McMullen Kara 
Published: May 2023

Abstract

Introduction
Previous studies demonstrate that historically marginalized individuals living with burn injury received comparable physical and occupational therapy services to non-marginalized groups. However, other outcomes are not well studied in these groups. This study aims to examine functional outcomes of historically marginalized burn population.

Methods
Data was obtained from the Burn Model System National Database between 1993 and 2015 for adults alive at discharge. The marginalized group was defined as: age &gt;65; non-White; Hispanic; Medicaid or public support/indigent; homeless; drug or alcohol misuse prior to injury. Demographic and clinical characteristics were examined. Function was compared between groups (marginalized vs. non-marginalized) using the SF-12/VR-12 Physical (PCS) and Mental Component Summary (MCS) Scores at 6 and 12 months after injury.

Results
The sample included 583 participants (69.3%, n=404 marginalized group), was 83.9% white, and mean burn size was 16.7% (SD 17.6) total body surface area. Follow-up status was not significantly different between groups at 12 (p=0.115) and 24 (p=0.250) months. The non-marginalized group had higher PCS and MCS scores at 6 months than the marginalized group (Table). There were no significant differences in outcomes between groups at other time points.

Conclusions
The marginalized group exhibited worse physical and mental function scores than the non-marginalized group. This suggests that despite similar follow-up rates marginalized populations have worse outcomes.

Applicability of Research to Practice
Differences in functional scores between groups suggest that patients from historically marginalized groups may require more resources to achieve similar outcomes to their non-marginalized counterparts. Further research is necessary to delineate the unique needs of historically marginalized groups and design interventions to achieve equitable outcomes.
509 Relationship of Full Thickness Burn And Volume of Initial Fluid Resuscitation After Major Burn Injury
Authors: Jain Arpana , Islas Claudia , Kabir Samin , Le Dora , Guntu Rachna , Richey Karen , Foster Kevin 
Published: May 2023

Abstract

Introduction
Full thickness burn injury affects the host response to burn injury differently that partial thickness burn injury. Current guidelines for initial resuscitation calculate fluid infusion based on Total Body Surface Area (TBSA) affected and patient’s weight. The widely used formula does not offer guidance based on the depth of the injury. We present an investigation into relationship of full thickness burn injury on fluid resuscitation. This study was approved by our Institutional Review Board.

Methods
We performed a retrospective review of patients’ charts who were admitted after major burn injury of greater than 20% TBSA to a busy regional burn center. We included patients over age of 14 years admitted from year 2014-2019. We excluded patients who did not have complete resuscitation data, allowing 99 patients for analysis. We performed t test to uncover relationship of age, gender, body weight, TBSA and percent of full thickness burn with fluid received during initial resuscitation with significance set at p &lt; 0.05.

Results
The volume of fluids given during initial resuscitation was significantly affected by gender and full thickness burn injury. Fluids requirement for females was 4.6ml/kg/TBSA vs males was 3.3ml/kg/TBSA (p value 0.04). Fluid requirement for full thickness burn was 8.4ml/kg/TBSA vs 3.7ml/kg/TBSA for all patients (p=0.0004). Initial fluid resuscitation fluids did not have significant relationship with age, body weight or overall TBSA.

Conclusions
This study demonstrates that full thickness burn injury has a significant impact on initial fluid resuscitation. Further research is needed to elicit the mechanism to explain the higher fluid requirement for full thickness burn injury.

Applicability of Research to Practice
Our study brings attention to the effect of depth of burn injury on the actual volume of fluids needed during initial resuscitation of burn injury. This study will alert the clinician to take into account both the surface area as well as depth of the burn injury while embarking on fluid resuscitation after a major burn injury.
510 Outcomes for Patients with SJS/TENS with Diabetes Compared to other Comorbid Conditions
Authors: Chandran Keshav , Hink Ashley , Kahn Steven , Ozhathil Deepak 
Published: May 2023

Abstract

Introduction
Stevens-Johnson Syndrome (SJS), toxic epidermal necrolysis (TEN), and SJS/TEN Overlap Syndrome are on the same spectrum of severe blistering skin diseases that affect the skin and mucosal surfaces of the body. They have an immunological etiology and are caused by toxins, drugs, or infectious agents. The mortality rate for patients with these conditions is high, but there is limited research on the outcomes for those patients with additional comorbidities. This study investigates the association of inflammatory conditions such as diabetes mellitus, obesity, and tobacco usage have on the outcomes of patients with SJS or related disease. It was predicted that each of these comorbidities would be associated with higher rates of mortality and disease complications.

Methods
This study is a retrospective observational cohort study using a commercially available large database, which provides deidentified electronic medical data from health care organizations all over the world. Our database was used to perform a search and analysis for patients with SJS, SJS-TEN Overlap Syndrome, and TEN as well diabetes mellitus (DM), tobacco usage (TU), or overweight/obesity status. A fourth, control cohort of patients without any comorbidities was also included. In total, 8,962 patients were included in the study: 6,348 patients in the control group; 426 patients in the TU group; 1,186 patients in the DM group, and 1,002 patients in the Obesity group. Outcome variables measured were rate and incidence of pneumonia, sepsis, and endotracheal intubation. Outcome variables from each of the four cohorts were analyzed with a total of six unique comparisons.

Results
Compared to the control group, the DM group had a mortality rate 14.3% higher (CI 95%, 11.8% -16.9%), pneumonia rate 7.6% higher (CI 95%, 5.4%-9.9%), sepsis rate 4.7% higher (CI 95%, 6.9%-11.4%), and endotracheal intubation rate of 1.9% higher (CI 95%, 0.8%-3.0%). Furthermore, compared to the Obesity group, the DM group had a mortality rate 11.6% higher (CI 95%, 8.5%- 14.8%) and sepsis rate 4.7% higher (CI 95%, 1.7%-7.6%). Compared to the TU group, the DM group had a mortality rate 12.4% higher (CI 95%, 8.5%- 16.3%) and sepsis rate 8.1% higher (CI 95% 4.7%-11.6%). Besides this data on the DM group, the Obesity group showed statistically significant worse outcomes as well. Compared to the control group, the Obesity group showed a mortality rate 2.7% higher (CI 95%, 0.5%-4.9%), pneumonia rate 5% higher (CI 95%, 2.7%-7.3%), sepsis rate 4.5% higher (CI 95%, 2.3%-6.6%), and intubation rate of 2.1% higher (CI 95%, 0.8%-3.4%).

Conclusions
Using a large multi-institutional database, Diabetes mellitus is associated with worse outcomes for patients with SJS, SJS-TEN overlaps, or TEN compared to obesity and tobacco usage.

Applicability of Research to Practice
This data argues the importance of examining a patient’s past medical history when evaluating their prognosis for SJS, SJS-TEN overlaps or TEN.