An analysis of social support and insurance on discharge disposition and functional outcomes in patients with acute burns.

Impairment and burn injury outcomes are often influenced by an intermingling of physical and psychosocial factors. We hypothesized that patients without insurance would be more likely to return home. We also believed that patients with inadequate social support would be less likely to return home. The data for this report comes from a prospective study of 252 patients aged 16 and older who were discharged from an acute burn unit between February 2004 and December 2006. As a group, only 4 of 71 uninsured patients were discharged to post-acute inpatient care, compared to 48 of 181 insured patients. Of the 200 patients discharged to home, 92% had adequate social support. Of the 52 patients not discharged directly to home, only 38.5% had adequate support. By using a chi-square analysis, patients with social support were 44.642 times more likely to be discharged to home when compared to patients without social support. Patients without insurance were almost seven times more likely to be discharged to home. Average Functional Independence Measure (FIM) scores were assessed. The group with the lowest FIM scores are patients lacking adequate social support; subjects in this group are also generally older in age. In contrast, our uninsured group has significantly higher FIM scores, and also tends to be younger in age. Physical predictors of disposition include TBSA of injury, age, sex, and presence of inhalation injury. Our study illustrates that social support and access to insurance are important variables that predict outcome and disposition.