OBJECTIVE: To demonstrate the dissonance between the expectations of the (I) trauma providers, the experience of (2) patients, and the accepted responsibility of the policy makers, to include (3) hospital administrators, (4) legislators, and (5) insurance company administrators. This pilot study attempts to demonstrate the discrepancies between the five subject populations involved.
METHODS: The Trauma Recovery Survey (TRS) was distributed to 50 trauma patients from a level I trauma institution in Oregon; 309 trauma providers (e.g., physicians, nurses); 265 hospital administrators (e.g. , CEOs, COOs, VPs, directors); and 345 legislators (e.g., congressmen, committee members) throughout Oregon and Washington. The TRS was developed for the purpose of this study, in order to evaluate the beliefs and attitudes of the five subject populations on a variety of outcome facets that include: physical, occupational, financial, legal, psychological, addiction, social and insurance.
RESULTS: Seven patients returned surveys (16.3%); all Caucasian females with an average age of 39.3yrs and an average ISS of 14.9 (Range 3-27). The mean education was 14.9 yrs (patient), 17.1 yrs (legislator), 17.6 yrs (administrator), and IS.7 yrs (provider). The average age and gender distribution of providers was 45 .3yrs (M59%:F41 %); administrators, 50. I yrs (M56%:F44%); and legislator, 55.3 yrs (M53%:F47%). Length of recovery was underestimated (p=0.020) by individuals without injury (49.5%) as compared to those with injury to self or a loved one (50.5%). Patients reported a loss of income, which was underestimated by both the provider (p=0.021) and administrator (p=0.017); and they felt that the treatments and services available to them following discharge were less adequate than the administrator (p=0.047) and the legislator (p=0.013). Two counterintuitive findings include: patients felt they had adequate pain control compared to the perception of the providers (p=0.031) and administrators (p=0.021); and patients felt they recover from psychiatric problems whereas provider (p=0.034), administrator (p=0.038), and legislator (p=0.010) felt they did not. Providers felt treating drug and alcohol dependence was essential when compared to the patient (p=0.026), because they knew that substance abuse is a risk factor for a second trauma (p=0.001). Correlations were made within the psychiatric and substance abuse domains in which the provider and the legislator were found to have paralleling views and the administrator group felt differently on key issues. Interestingly, providers (p=0.020) and administrators (p=0.033) felt that the importance of a faith-based groups was greater than that felt by the patient. The top three greatest concerns during the Firs! Few Days for the patient were pain, function, and disability, where as the provider, administrator, and legislator ranked survival, pain, and disability. At 6-months, finances, disability and function were the concerns to all groups. Lastly, there were significant findings within the insurance domain, but the insurance subject group data were not available.
CONCLUSIONS: A dissonance between the trauma patient, provider, administrator, and legislator exists. Areas of greatest concern include the perception of length of recovery and treatments and services available to the trauma patient. Knowing that these components are important and the perceptions of the individuals involved in trauma are often different; plans for education regarding recovery and an evaluation of the available treatments and services should commence. Functional outcome and recovery are important, thus the trauma system should make end roads to creating a holistic approach to treating the trauma patient.
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