A Survey of Access to Care in the TRICARE Environment


Name: Bonnie Jennings

Rank: COL, USA

Organization: The Geneva Foundation

Performance Site: Madigan Army Medical Center, Tacoma, WA

Year Published: 1996

Abstract Status: Final


The objectives of this descriptive correlational study, which was conceptually supported by Selye's General Adaptation Syndrome, were to (1) determine the reliability of two methods for measuring burn wound healing, (2) examine the variables that affect wound healing, and (3) correlate the cost of inpatient treatment with the variables that affect wound healing. The two methods used to quantify wound healing were subjecting photographs to computerized image analysis to determine the total wound area and calculating a burn wound severity score (BWSS). Correlates to wound healing examined were nosocomial infection (NI), post-burn nutritional status, pre- and post-burn stress levels, demographics, current medical conditions, and burn wound characteristics.A total of 47 burn subjects' wounds were clinically assessed and photographed at baseline and thereafter at regular intervals. Physiologic and psychometric methods were used to examine correlates to wound healing. Pre-burn stress was measured with the Perceived Stress Scale (PSS), and pre-burn tobacco, alcohol, and drug use were measured with investigator-developed instruments. Post-burn psychological stress was estimated with salivary cortisol level determinations and the Impact of Event Scale (IES). NI was operationalized according to Centers for Disease Control and Prevention guidelines and was identified by expert surveillance.The most important predictor of wound healing was found to be the log of the original burn area. The BWSS was determined to be unreliable as a method for measuring burn wounds, but image analysis of wound photographs was found to be useful and can assist nurses in assessing which burn treatments/therapies provide the best outcomes.Length of hospital stay was positively correlated with receiving oxandrolone, greater area burned, greater percentage of third-degree burns, the incidence of NI, and elevated cortisol levels. Cost of treatment was positively correlated with a greater body surface burned and alcohol abuse.


Final report is available on NTRL: https://ntrl.ntis.gov/NTRL/dashboard/searchResults/titleDetail/PB2008112...