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Dr. Michael Choo: Meeting High-Intensity Burn Injuries with High-Impact Care

WorkCompWire
Full article on: workcompwire.com

The dramatic improvements in burn injury care and survivability over the past several decades deserve much recognition and attention for their impact on patient outcomes and recovery. Thanks to technological innovations and advancements in treatment—including surgical critical care, antimicrobials, nutritional replacements, medical technologies, skin substitutes, and novel skin grafting techniques—we have seen as much as a five-fold decline in burn-related deaths since 1980.1 When combined with safety improvements in both the workplace and home, the overall result has been both lower frequency and mortality rates for these extremely complex and life-changing injuries.

Despite these undeniably positive developments, catastrophic workplace burn injuries remain one of the most serious and costly injury classes in the workers’ compensation system. According to data from the National Council on Compensation Insurance (NCCI), burns are second to motor vehicle accidents as the highest-costing lost-time claims by cause of injury.2 These cases are among the most complex forms of traumatic injury, causing a range of physical and psychosocial concerns that often substantially and permanently affect normal function and require long-term rehabilitation.

Although technology and care innovation have resulted in miraculous and life-saving advancements in burn management, they are undoubtedly correlated with increased medical costs. Due to the devastating impact on the body and residual lifetime needs that are consequential from these severe burns, our industry needs to understand the necessity of compassionate interventions that truly address the long-term complications of these injuries. As the priority for injury management moves beyond survivability into improving quality of life and function, balancing outcomes and value of care requires a specialized approach built on research and expertise that fully understands this unique injured worker population.

Understanding workplace burn injuries—types and industries
Work-related burn injuries can run the gamut from thermal burns caused by an explosion or flareback to chemical burns and destructive electrical burns. The vast majority—more than 80%—of injured workers diagnosed with burn injuries come from the service and manufacturing industries.3 When considering catastrophic burns, 60% of cases come from the manufacturing and contracting job categories.3 Specific high-risk occupations for burn cases that result in more than $500,000 in spending include transportation, electrical wiring, power line construction, and chemical manufacturing.3

High-impact catastrophic burn injury treatment in action
Severe burns are synonymous with high-intensity and extremely complex care needs and have a devastating impact on nearly every organ system of the body, including skin, muscles, nerves, blood vessels, and bones. They are extremely painful, cause significant functional disability, extreme post-traumatic stress and psychosocial impacts—and often bring long-term challenges related to physical appearance and self-image.

Catastrophic burn care takes an army of expert medical professionals—surgeons, medical specialists, wound care specialists, pain management specialists, rehabilitation therapists, nutritionists, and behavioral health professionals—who must work closely together to deliver the right treatments, at precisely the right time, to achieve a positive outcome. In these cases, specialized systematic care management plays a critical role in effective care plan development and coordinating a disparate and multifaceted team of providers—while delivering informed and experienced communication.

What makes burn injury care even more unique and perilous is the high-intensity nature of treatment needed for the full duration of the case. In contrast to other injury classes that generally start out with complex care needs but stabilize during recovery, burn injuries typically have a high-risk, high-complexity treatment profile from beginning to end in order to manage the long list of complications and dysfunctions. From initial skin graft procedures that require constant vital sign monitoring, antibiotic administration, and fluid infusions, to managing scar contractures and thermal regulation changes, through lifetime emotional and psychological adjustment challenges, care timelines for severe burns are measured in years and decades instead of weeks and months.

Frontiers in improving quality of life and outcomes
Due to the intensive and highly specialized nature of burn injury care, achieving meaningful improvements in functional outcomes and quality of life requires a steadfast commitment to research and the development of model systems that create clinical benchmarks for recovery, rehabilitation, and life adjustments. To meet this need, the National Institute on Disability, Independent Living, and Rehabilitation Research created and funded four burn model systems across the United States, including the Boston-Harvard Burn Injury Model System (BHBIMS)—where I am an advisory member and provide insights from Paradigm’s 30+ years of outcome management of complex burn injuries to advance workers’ compensation research and care.

This network of hospitals and research institutions works to improve the state of burn care through a wide range of initiatives, including research on treatment advances such as laser therapy for scar treatment, to developing the decision support tools and monitoring capabilities needed for the next generation of burn providers.

One especially noteworthy BHBIMS project I was excited to support and advise is the Life Impact Burn Recovery Evaluation (LIBRE). This recent initiative, led by Jeffery Schneider, MD, and Lewis Kazis, ScD, successfully provides data-driven recovery trajectories and benchmarking of functional outcomes expectations specific to social participation—including work and employment domains of burn survivors during their post-injury recovery years. This carefully developed LIBRE profile tool enables the real-time monitoring and better understanding of individual burn survivor’s social integration and engagement trajectories compared specifically with the burn injury population. This tool, which includes a mobile app for injured workers to anonymously and privately self-score their recovery status, is an example of a highly valuable patient-centric digital assessment platform that underscores the importance of real-time injured worker engagement tools to optimize functional outcomes.

Anyone can access this insightful LIBRE tool via download links, see below:

As Dr. Schneider explains, “Enabling burn survivors to self-assess their own social integration recovery is a critical step for building individualized care plans and ultimately guiding social integration resources for the burn survivor community as a whole.”

Such ongoing commitment to burn research, innovation, and continuing care improvements will contribute to furthering burn survivability, recovery, and restoration of patients to their highest functional outcomes and quality of life. At the same time, the reality of such emerging novel burn care will require a substantial investment in terms of time, diagnosis-specific expertise, and costs of care for the foreseeable future. Hence, as with all catastrophic injury conditions, the focus needs to be on understanding what appropriate holistic whole-person care is—at the present and in the future—to achieve the best functional outcomes and positively impact the total cost of care.

About Dr. Choo
Dr. Michael Choo is Paradigm’s Chief Medical Officer, Workers’ Compensation. He maintains the company’s relationships with its network of consulting physicians and centers of excellence, and is responsible for enhancing clinical operations and leading outcomes research and development. ​

Prior to joining Paradigm, Dr. Choo was President and CEO of CHM Regional Health System in Wilmington, Ohio, where he oversaw its transition from county-owned nonprofit to a private-equity-funded for-profit hospital. ​

Dr. Choo holds his BA and MD from Boston University’s accelerated six-year honors program in medicine, as well as an MBA from the University of Tennessee’s Haslam Graduate School of Business. He is a senior oral board examiner for the American Board of Emergency Medicine, a fellow of the American College of Emergency Physicians, and a fellow and board member of the American Academy of Emergency Medicine.

Sources

  1. American College of Surgeons. “Burn Specialists Report a Dramatic Increase in Burn Injury Survival Rate Over the Past 30 Years,” March 9, 2018.
  2. NSC Workers’ Compensation Costs: https://injuryfacts.nsc.org/work/costs/workers-compensation-costs/
  3. NCCI, 2021:  https://www.ncci.com/Articles/Documents/Insights-Workers-Compensation-Burn-Injuries.pdf