Predicting resource utilization of elderly burn patients in the baby boomer era.

BACKGROUND: Census predictions for Florida suggest a 3-fold increase in the 65 and older population within 20 years. We predict resource utilization for burn patients in this age group. METHODS: Using the Florida Agency for Healthcare Administration admission dataset, we evaluated the effect of age on length of stay, hospital charges, and discharge disposition while adjusting for clinical and demographic factors. Using US Census Bureau data and burn incidence rates from this dataset, we estimated future resource use. RESULTS: Elderly patients were discharged to home less often and were discharged to short-term general hospitals, intermediate-care facilities, and skilled nursing facilities more often than the other age groups (P < .05). They also required home health care and intravenous medications significantly more often (P < .05). Their length of stay was longer, and total hospital charges were greater (P < .05) after adjusting for sex, race, Charleson comorbidity index, payer, total body surface area burned, and burn center treatment. CONCLUSIONS: Our data show an age-dependent increase in the use of posthospitalization resources, the length of stay, and the total charges for elderly burn patients.

Hand injuries in the state of Florida, are centers of excellence needed?

INTRODUCTION: Hand injuries are common and costly. The need for hand surgery specialists is undeniable. In the state of Florida, the availability of specialty services in hand surgery is limited. Florida ranks 4th in population and 32nd in hand surgeons per 100,000 state residents. Recent media reports highlight these limitations among hand surgeons and other specialists in the state. METHODS: To evaluate the need for hand surgery centers of excellence in the state, we performed a retrospective review of data collected from the Agency for Health Care Administration database of hospital inpatient admissions from 1997 to the second quarter of 2007. Demographic information, details of the injury, and outcome data were evaluated in patients with amputation injuries. Amputations of the thumb, fingers, and hand/wrist/forearm were counted and factors associated with these injuries were recorded. Place of occurrence and injuries caused by machinery were evaluated. A regression analysis was performed to evaluate trends in the number of amputations and replantation procedures. RESULTS: We identified 4,858 patients with amputations in this time period. There were approximately 462 amputations per year. The trend in finger amputations appeared to be increasing yearly, whereas the trend for replantation surgery was decreasing. Six percent of the hospitals recording admissions with the Agency for Health Care Administration performed 68% of the replantation surgeries in the state. We also noted an increasing proportion of patients being admitted and treated outside of their own county and region. CONCLUSION: With fewer replantation surgeries performed and patients traveling farther for treatment we conclude that there is a need for coordinated evaluation, triage and treatment of patients with hand injuries requiring specialized hand surgery services at centers of excellence in Florida.