Utilization and Costs of Outpatient Social Work Services Among Patients with Combat-Related Polytrauma at the James A. Haley Hospital Between 2007 and June 2011

• Other Authors: Albright, David L. (authoraut)
• Format: Others
• Language: English; English
• Published: Florida State University
• Subjects: Social service
• Online Access: http://purl.flvc.org/fsu/fd/FSU_migr_etd-4688

Purpose: The purpose of this exploratory study was to examine outpatient social work service utilization and associated costs among patients with combat-related polytrauma who received services at the James A. Haley Veterans' Hospital between 2007 and June 2011. Design and Methods: The research design is a retrospective cohort study using secondary data extracted from the Veterans Health Administration Medical SAS Outpatient and CPRS databases. The sampling strategy is purposive and nonrandom with a sample size of 265. Descriptive statistics and nnegative binomial regression modeling were used to address the research objectives. Results: Combat-related polytrauma patients had a total of 10,437 outpatient social work service encounters between 2007 and June 2011. Patients received 91 different outpatient social work service procedures for a total number of 8,564 outpatient social work service procedures. Unlisted evaluation and management services accounted for 51% of the diagnoses. Patients receiving outpatient social work procedures were coded with 115 different diagnostic codes for a total number of 3,457 diagnostic codes. Unspecified psychosocial circumstances accounted for 48% of the coding. Social workers were the largest providers of outpatient social work service procedures accounting for a total of 10,031 procedures. The total associated costs were $3,830,379. The rate of social work service encounters for females was 77% less as compared to men (IRR=.23), when controlling for age, ethnicity, marital status, mechanism of injury, and race. Married patients had a 48% lower rate of social work service encounters than single patients (IRR=.52), when controlling for age, ethnicity, gender, mechanism of injury, and race. Asian patients had a 37% lower rate of social work service encounters than white patients (IRR=.63), when controlling for age, ethnicity, gender, marital status, and mechanism of injury. American Indian patients had an 87% lower rate of social work encounters than white patients (IRR=.13), when controlling for age, ethnicity, gender, marital status, and mechanism of injury. Conclusions: Results suggest that there are disparities in the utilization of outpatient social work services at the James A. Haley Hospital between 2007 and June 2011. Healthcare providers and policy makers should be aware that female, married, Asian, and American Indian veterans with combat-related polytrauma are less likely to use outpatient social work services. Additionally, there are inconsistencies between the services provided by the Polytrauma Rehabilitation Center social work case managers and the way these services are coded. The highest frequencies for procedural and diagnostic coding are "unspecified". The provision of social work services need to be studied in order to maximize efficiency, cost-effectiveness, and the quality of care being provided to combat-related polytrauma veterans. Finally, results suggest the research studying the role of social work case management in the continuum of care is limited. Current studies do not specifically focus on veterans with polytrauma or TBI using social work services despite explicit policy directives indicating the essential role those services have within the continuum of care. === A Dissertation submitted to the College of Social Work in partial fulfillment of the requirements for the degree of Doctor of Philosophy. === Spring Semester, 2012. === March 26, 2012. === Case Management, Polytrauma, Social work, Traumatic Brain Injury, Veterans === Includes bibliographical references. === Bruce A. Thyer, Professor Directing Dissertation; Betsy J. Becker, University Representative; Stephen J. Tripodi, Committee Member.