Shriners Improves Care for Young Burn Patients

Photo by Graham Ramsay Erica Seiguer

In a time when headlines about rising health care costs are ubiquitous, the concept of free care may seem unlikely. Yet, across the nation and right here in Boston, children treated at specialized burn centers established and supported by the Shriners organization receive state-of-the-art burn care and comprehensive psychosocial and rehabilitative services free of charge. The Boston Shriners Hospital is the only certified pediatric burn center in all of New England.

At the Shrine, as it is known familiarly, 240 severely burned children are treated each year. There, 850 children receive reconstructive surgery and 1,800 operations take place annually. Each year, 7,000 kids are seen as outpatients.

Growth of Free Care
The Shrine is part of a hospital system founded in the 1920s to treat kids with congenital orthopedic deformities such as club foot. Begun in Shreveport, Louisiana, by a Freemasons club that raised funds to establish endowments, the Shriners hospital system eventually consisted of 19 orthopedic hospitals across the country. By the 1960s, it shifted gears and began to focus on burns, establishing three specialized burns hospitals nationwide accredited by the American College of Surgeons, including Boston’s Shriners in 1968. A fourth burns hospital was established in 1997.

Each hospital’s costs are paid by the Shriners organization, allowing all care within the walls of the hospital to be free. It also provides financial support for patients and their families to travel to and from the hospital for comprehensive long-term care. In 2005, the Shriners hospitals treated more than 120,000 patients free of charge.

The Dimensions of Quality
In the 1990s, physicians and researchers at Boston Shriners set about to study the long-term outcomes for severely burned children, those with over 70 percent of their body burned. They wanted to know how these children were doing physically and emotionally. At the time, survival from burns was becoming more and more common, and there was concern about the quality of life these children would experience. The study was led by Robert Sheridan, chief of burn surgery and assistant chief of staff at Boston Shriners and an HMS associate professor of surgery. The results were published in 2000 in The Journal of the American Medical Association.

The research team found that the children treated at the Shrine over the years 1969 to 1992 were doing remarkably well, with ratings for quality of life similar to their age-matched peers who did not suffer burns. About 15 percent of the patients had ratings of physical functioning significantly below the average for their peers, however. The team found that patients with more intact and functioning family units and those children integrated back into school within four months of injury reported better health and physical functioning.

The results “surprised me a bit,” said Sheridan. “At the time that we conducted the study, I did not have as much long-term experience with the children I had treated. Now, after I have had the chance to follow patients for more than 15 years, the findings are not as surprising.” Sheridan attributes the good quality of life reported by children to the improvements in medical and surgical care available to them and the aggressive and experienced psychosocial support available at the Shrine.

“Pain control has improved by orders of magnitude,” Sheridan said, “and we are seeing much less treatment-related acute stress disorder.” He explained that at specialized and concentrated centers like the Shrine, reconstructive surgery is done earlier, leading to better aesthetic results and better function. Further, in these settings, care is much more efficient.

One of the major findings of the study is the importance of the family, and the authors suggest that family services are thus integral to an injured child’s recovery. According to Sheridan, the specific aspects of family life that predict better outcomes have yet to be sorted out. He emphasized that the Shrine’s program, with its active family services and care coordinators who assist families in being savvy about available community services and school reintegration, has had a major impact on outcomes.

School reintegration involves the organization of a schoolwide assembly during which physicians from the hospital, along with school officials, discuss what happened to the burned child. This intervention seems to reduce the isolation of the child and has been found to be very helpful, according to parents and school administrators.

The JAMA study relied on a survey tool called the Short Form 36 (SF-36), a widely used and extensively validated survey for measuring health-related quality of life. The SF-36 is not aimed specifically at children with burns, but the American Burn Association and the Boston Shriners Hospital are currently working on developing a survey tool to do just that. Sheridan and his colleagues are also considering updating their 2000 study to track more children treated in the years since 1992.

—Erica Seiguer is an MD–PhD student studying economics in Harvard’s Doctoral Program in Health Policy.

Related Website
Shriners Hospitals for Children

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