Outcomes following intensive allied health therapy in the acute hospital for trauma patients.

L Kimmel, M Webb, D McCaskie, V Maric, M Fitzgerald, B Gabbe
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Abstract

The majority of patients hospitalised for trauma survive their injuries, with the quality of the survival potentially influenced by early acute hospital rehabilitation. The aim of this study was to review the outcomes of patients managed under an intensive Allied Health Model of Care (AHMOC) compared to a baseline cohort.

Methods: The AHMOC was commenced in February 2020 on the Trauma ward at Alfred Health for 12 months. The baseline group included patients admitted to the trauma ward in 2019. All patients who were registered by either the Victorian Orthopaedic Trauma Outcomes Registry (VOTOR) or the Victorian State Trauma Registry (VSTR). The association between the groups (AHMOC and baseline) and outcomes were assessed using logistic (discharge destination, 12-month return to work) and linear (length of stay (LOS)) regression.

Results: There were 1644 in the baseline group and 1732 in the AHMOC group, of which 70 % and 76 % respectively were discharged directly home from the acute hospital (p value < 0.001). The trauma ward LOS was 4.0 days for each group (p value 0.77). After accounting for confounders, the adjusted odds of discharge home and RTW at 12 months were 53 % (AOR 1.53 95 % CI 1.29, 1.82) and 65 % (AOR 1.65 95% CI 1.24, 2.21) higher for the AHMOC group compared to baseline, respectively. There was also a 6 % reduction in the LOS in the AHMOC group compared to baseline (Adjusted mean difference 6 %; 95 % CI (0.881, 0.999) p value = 0.050).

Conclusion: This study shows an association between an AHMOC for trauma patients with a focus on early and intensive therapy and improved odds of discharge directly home, as well as improved 12 month return to work outcomes.

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创伤患者在急症医院接受联合医疗强化治疗后的效果。
大多数因外伤住院的患者都能存活下来,而早期急性期医院康复治疗可能会影响患者的存活质量。本研究的目的是对在强化联合医疗模式(AHMOC)下管理的患者的治疗效果进行回顾,并与基线队列进行比较:AHMOC 于 2020 年 2 月在阿尔弗雷德医疗中心的创伤病房开始实施,为期 12 个月。基线组包括2019年入住创伤病房的患者。所有患者均在维多利亚骨科创伤结果登记处(VOTOR)或维多利亚州创伤登记处(VSTR)登记。采用逻辑回归(出院目的地、12个月内重返工作岗位)和线性回归(住院时间(LOS))评估各组(AHMOC和基线)与结果之间的关联:基线组有 1644 人,AHMOC 组有 1732 人,其中分别有 70% 和 76% 的人从急症医院直接出院回家(P 值小于 0.001)。两组的创伤病房生命周期均为 4.0 天(P 值为 0.77)。考虑到混杂因素后,与基线相比,AHMOC 组 12 个月后出院回家和 RTW 的调整后几率分别高出 53% (AOR 1.53 95% CI 1.29, 1.82) 和 65% (AOR 1.65 95% CI 1.24, 2.21)。此外,与基线相比,AHMOC 组的 LOS 减少了 6%(调整后平均差 6%;95% CI (0.881, 0.999) p 值 = 0.050):这项研究表明,创伤患者接受以早期强化治疗为重点的 AHMOC 与提高直接出院回家的几率以及改善 12 个月重返工作岗位的结果之间存在关联。
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