Manage complex problems, comorbidity and health disparity


Care for Patients with Multiple Severe Injuries, Comorbidities and Health Disparities


My presentation about using the best scientific evidence based care to improve quality of life, function, survival and health for injured workers withh multiple severe comorbidities, health disparities in complex situations and the current health care environment.  

This was as fun and exciting as any come from behind upset victory.

Physical Medicine & Rehabilitation management of complex work injuries with pain to prevent complications, disability and narcotic use while returning to health, function, exercise, self management and work.

Brooke MM: Pilot Physiatry Model of Postacute Care for Patients with Multiple Severe Injuries, Comorbidities and Health Disparities. Am J Phys Med Rehabil, 94:508, 2015.

Objectives: Patients are being discharged to post-acute care after more severe injuries, shorter acute stays and less social support. The most common comorbidity is multiple comorbidities. Patients with disabilities and health disparities may not find a doctor. With rapid change in healthcare and decreased physician funding, there is a need to evaluate the characteristics of patients who cannot find a post acute physician and the feasibility of physiatry and rehabilitation care. Physiatry, rehabilitation and the team model of care has been cost effective in pediatric, military, spinal cord injury, brain injury and mental health. Physiatry and rehabilitation may be increasingly important as we try to decrease the poor national outcomes regarding disability, exercise, diabetes, cardiovascular disease and patient compliance.

Design: One physiatrist accepted all patients presenting without discrimination, and the clinic provided the basics including vital signs, interpreters and front office scheduling functions. There may have been more than average experience and commitment to providing comprehensive care. Data was collected regarding demographics, injuries, comorbidities, health disparities, health utilization and outcomes. One insurance funding agency identified two months of their patients for review.

Results: The 24 patients in need of a physician were very different than the average for the state insurance company. They had two major injury diagnoses, more than two significant comorbidities, more than one surgery, 79% procedures, 683 days case open and 71% interpreters. They had fewer complications and adverse outcomes.

Conclusions: This limited study suggests a need for larger multicentered post-acute studies. An individual physiatrist was able to provide not only missing physician care, but also rehabilitation, primary care, cost effective and self-efficacious patient engagement without complications from procedures, surgeries, excess narcotics and adverse outcomes. There is a need for further studies regarding multiple injuries, comorbidities, health disparities and availabilities of physician access, rehabilitation, pain care and outcomes.

Association of Academic Physiatrists, San Antonio March 12, 2015