599 A Retrospective Outcome Analysis of the Involvement of Department of Child Services in Suspected Cases at a Major Regional Pediatric Burn Center

Introduction Cases of child abuse are an important manifestation of pediatric burns owing to their nature and all too common occurrence. In our institution, the Department of Child Services (DCS) is often frequently involved in minimally suspicious cases in conjunction with or even before the internal child protective team involvement. To our knowledge, there is no recent literature evaluating the outcome of DCS involvement in suspected cases in pediatric burn populations. Methods We performed a retrospective chart analysis of the pediatric burn patient database at our institution from 2017–2020. We identified 116 out of 565 patients who matched our criteria for the involvement of DCS. We collected the following information: age, race, address at time of injury, payer source, where DCS involvement was initiated, and the outcome of the investigation. Results We found that 20.5 % of all the pediatric burn patients admitted from 2017–2020 had DCS involvement. Of the total admitted patients only 3.8% were removed from the previous caregivers. The factors that were found to be statistically significant were male sex, age under 3 years, Caucasian child with single parent and living in an urban setting. A higher incidence was noted in the capital city area compared to the rest of the state. There was no statistical difference noted among races, location of DCS notification, and payer source. Conclusions We conclude that vigilance and early reporting is essential in detecting child abuse. Involvement of the multidisciplinary child protection team at our institution may reduce the burden on DCS. Screening out high risk factors such as age less than 3 years old, male sex, and single parent of Caucasian race may assist in detecting the non-accidental burn victims. We will target prevention educational outreach programs to the community to decrease the occurrence of child abuse in the future.

Predictive Factors for Patients’ Failure to Show for Initial Outpatient Physical Therapist Evaluation

Objective The objective of this study was to xamine primary factors which may predict patients’ failure to show at initial physical therapist evaluation in an orthopedic and sports outpatient setting. Methods A retrospective analysis of patients’ demographic data for physical therapist evaluations between January 2013 and April 2015 was performed. A binary logistic regression model was used to evaluate the odds of a no-show at evaluation. Demographic variables of age, employment status, days waited for the appointment, payer source, and distance traveled to clinic were analyzed. Independent variables were considered significant if the 95% Cis of the odds ratios did not include 1.0. Results A total of 6971 patients were included in the final analysis with 10% (n = 698) of the scheduled patients having a no-show event for their initial evaluation. The following factors increased the odds of patients having a no-show event: days to appointment (OR = 1.058; 95% CI = 1.042 to 1.074), unemployment status (OR = 1.96; 95% CI = 1.41 to 2.73), unknown employment status (OR = 3.22; 95% CI = 1.12 to 8.69), Medicaid insurance (OR = 4.87; 95% CI = 3.43 to 6.93), Medicare insurance (OR = 2.22; 95% CI = 1.10 to 4.49), unknown payer source (OR = 262.84; 95% CI = 188.72 to 366.08), and distance traveled ≥5 miles (OR = 1.31; 95% CI = 1.01 to 1.70). Female sex [OR = 0.73; 95% CI = 0.57 to 0.95) and age ≥ 40 years (OR = 0.44; 95% CI = 0.33 to 0.60) decreased the odds of a no-show event. Conclusion Results from this study indicate there may be some demographic factors that are predictive of patients failing to attend their first physical therapist visit. Impact Understanding the predictive factors and identifying potential opportunities for improvements in scheduling processes might help decrease the number of patients failing to show for their initial physical therapy appointment, with the ultimate goal of positively influencing patient outcomes.

Prevalence of Insufficient Serum 25-hydroxyvitamin D (25(OH)D) Greater Among Medicaid Residents Living in Long-Term Care Communities (P01-011-19)

Objectives Evaluate the association between insufficient 25-hydroxyvitamin D [25(OH)D] serum levels and healthcare payer source of older adults living in long-term care (LTC) communities. Methods Residents (age >65 yo) of five LTC communities in Central, Texas were recruited to participated in the multi-site, cross-sectional study. A one-year medical history was abstracted from medical records using double-blinded data abstraction and entry protocols. Medical history included but not limited to: diagnosis, medications, history of supplementation, BMI, mini-nutritional assessment, diet order, total mood assessments, hospitalizations and number of infections. Data on payer source and other demographics were also obtained via medical records. Blood draws were collected to measure serum 25(OH)D levels. Logistic regression models were uses to assess the association between insufficient25(OH)Dserum levels (defined as <30 ng/ml) and healthcare payer source. Total vitamin D supplemented per day along with amount provided in meals, body mass index, race, gender, age, years living in community, and diagnosis of liver and renal disease were used as confounders. Results The 174 participants (89% Caucasian, mean age 83 yo) included 63% females. Payer source was distributed as follows: 55% private pay, 8.6% Medicare, 35% Medicaid, and 1% insurance. Fifty-five % had insufficient25(OH)D serum levels (mean serum level = 32.6 ng/ml; mean supplementation rate of 1138 IU per/d). Insufficient serum levels were seen in 48% of participants with private pay (mean serum level = 36 mg/ml) and 58% with Medicaid (mean serum level = 30.5 ng/ml). Adjusted logistic regression showed that payer source was a significant determinant of insufficient25(OH)D serum levels. Medicaid residents had significantly greater odds of having insufficient 25(OH)D serum levels (adjusted odd ratio (OR) 3.26; CL: 1.25, 8.48; P = 0.015) than private pay participants. Conclusions Practitioners working in LTC can use these results to ensure equity in the provision of medical nutritional therapy across Medicaid residents and private pay residents. Funding Sources Funding for study was provided through the private funds of research team.

Payer Source Associated with Disparities in Procedural, but Not Surgical, Care in a Trauma Population

Trauma centers are legally bound by Emergency Medical Treatment and Active Labor Act to provide equal treatment to trauma patients, regardless of payer source. However, evidence has suggested that disparities in trauma care exist. This study investigated the relationships between payer source and procedures (total, diagnostic, and surgical) and the number of medical consults in an adult trauma population. This is a 10-year retrospective trauma registry study at a Level I trauma facility. Payer source of adult trauma patients was identified, demographics and variables associated with trauma outcomes were abstracted, and multivariate logistic regression tests were used to determine statistical differences in the number of procedures and medical consults. Of the 12,870 records analyzed, 69.1 per cent of patients were commercially insured, 21.2 per cent were uninsured, and 9.6 per cent had Medicaid. After controlling for patient- and injury-related variables, the commercially insured received more total procedures (4.30) than the uninsured (3.35) or those with Medicaid (3.34), and more diagnostic (2.59) procedures than the uninsured (2.03) or those with Medicaid (2.04). There was not a difference in the number of surgical procedures or medical consults among payer sources. This study noted that disparities (measured by the number of procedures received) compared by payer source existed in the care of trauma patients. However, for medical consults and definitive care (measured by surgical procedures), disparities were not observed. Future research should focus on secondary factors that influence levels of care such as patient-level factors (health literacy) and trauma program policies.

Comparison of Births by Provider, Place, and Payer in New Hampshire

This study examines maternity care in a rural state by birth attendant, place of birth, and payer of birth. It is a secondary analysis of birth certificate data in New Hampshire between the years 2005 and 2012. Results revealed that in New Hampshire, the majority of births occurred in the hospital setting (98.6%). Physicians attended 75.8% of births, certified nurse midwives attended 17%, and certified professional midwives attended 1%. Medicaid coverage was the payer source for 28% of all births, compared with 44.9% nationally. Women with a private payer source were more likely than women with Medicaid or other payer sources to have a cesarean section. The findings demonstrate quality of care outcomes among a range of clinicians and settings, providing a policy argument for expanding maternity care options.