Impact of a trauma recovery center on emergency department utilization for victims of violence

Background: Victims of violence are at high risk for unmet mental and physical health care needs which can trans-late into increased Emergency Department (ED) visits. We investigated the effectiveness of participation in a psy-chosocial, case management-based trauma recovery program on ED utilization.Methods: A retrospective cohort study of ED utilization before and after referral to a Trauma Recovery Center (TRC). Charts of TRC participants from 6/2017-5/2019 who consented in clinic to their medical records being used for research were reviewed. The primary outcome was the change in ED utilization 6 months pre-and post-referral to a TRC. The secondary outcomes were factors associated with ED visits after TRC referral, including victimization or mental health issues.Results: The study group contained 143 patients, of which 82% identified as female and 62% identified as white. Many (39%, n = 56) were part of one or more vulnerable populations and type of victimization varied exten-sively. Intervention uptake was high as almost all (92%, n = 132) had at least one TRC encounter [median of 6 encounters (IQR 2-13)] and an average of 2.7 services used. Most participants (67.1%, n = 96) had no change in ED use. Forty (28.0%) had at least 1 ED visit 6 months before, 38 (26.8%) had at least 1 ED visit 6 months after-wards, and 81 (56.6%) had no ED visits during either timeframe. ED visits per person in the 6 months prior to re-ferral were not different from visits per person in the 6 months after referral (0.52 vs 0.49, p = 0.76, paired t -test). Negative binomial regression indicated number of ED visits before referral (IRR 1.5, 95% confidence interval [1.27-1.79]) and pre-existing mental health conditions (IRR 2.2, 95% confidence interval [0.98-5.02]) were most associated with an increase in the incidence rate ratio of ED visits in the 6 months after referral.Conclusion: Despite high engagement, a multidisciplinary Trauma Recovery Center did not reduce ED utilization. ED utilization prior to TRC was the most predictive factor of ED utilization afterwards.(c) 2022 Published by Elsevier Inc.