Date of Award

1998-05-01

Degree Name

Doctor of Nursing Science

Dissertation Committee

Mary Jo Clark, PhD, RN, Chair; Janet K. Harrison, EdD, RN; Gary P. Schneider, PhD, CPA; Frank O. Thomas, MD, MBA

Keywords

Acute trauma care, Cost-effective analysis, Major trauma, nursing, Psychosocial

Abstract

The purpose of this triangulated descriptive study was threefold: (a) to identify the financial costs for acute trauma care, including costs for those who die early in treatment, and who pays those costs; (b) to identify the relationship between costs and severity of injury; and (c) to identify survivor functional and psychosocial costs, or quality of life, not only by current health care outcome criteria, but also from patients' and families' perspectives. Retrospective review determined the financial differences (total charges of $9,945,973 and institutional costs of $7,089,962) for 370 patients' severity of injury and functional outcomes at discharge, using the Glasgow Coma Scale (GCS), the Revised Trauma Score (RTS), the Injury Severity Score (ISS), and the Glasgow Outcome Score (GOS). One-way Analysis of Variance (ANOVA) identified statistically significant differences. Generally, moderately injured patients had higher lengths of stay (LOS) and correspondingly higher financial costs than more severely injured or less severely injured patients. More severely injured patients died in the Emergency Department (ED) or early in acute care; those with minor injuries were discharged sooner, leading to utilization of fewer health care resources by these two groups. Prospective review examined current physical function among survivors and psychosocial outcomes for survivors and family members. The Functional Independence Measure (FIM) found no significant differences in functional status among patients at 6 months to 1 year, 2 years, 3 to 4 years, or 5 years post-trauma. The Health and Daily Living Form B (HDL-B) survey, completed by 48 patients and 35 family members, identified psychosocial outcomes, with no statistically significant differences among patients or families at 6 months to 1 year, 2 years, 3 to 4 years, or 5 years post-trauma. Compared to community members, patients and families experienced more depression, more visits to mental and non-mental health professionals, fewer activities with friends, less substance (alcohol and tobacco) use, and more activities with families. Qualitative interviews with 20 patients and 18 family members, using a grounded theory approach, indicated that patients' and families' quality of life has improved post-trauma in spite of minor physical or financial setbacks. They have an increased appreciation for each other, for friends, and for life.

Document Type

Dissertation: Open Access

Department

Nursing

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