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Factors Influencing Nonadherence to Recommended Postdischarge Follow-Up After Trauma.
Truong, Evelyn I; DeMario, Belinda S; Hendrickson, Sarah; Kalina, Mark J; Vallier, Heather A; Tseng, Esther S; Claridge, Jeffrey A; Ho, Vanessa P.
Affiliation
  • Truong EI; Department of Surgery, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio.
  • DeMario BS; Department of Surgery, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio.
  • Hendrickson S; MetroHealth Medical Center, Community Trauma Institute, Cleveland, Ohio.
  • Kalina MJ; MetroHealth Medical Center, Community Trauma Institute, Cleveland, Ohio.
  • Vallier HA; Department of Orthopedic Surgery, MetroHealth Medical Center, Cleveland, Ohio.
  • Tseng ES; Department of Surgery, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio.
  • Claridge JA; Department of Surgery, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio.
  • Ho VP; Department of Surgery, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio; Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio. Electronic address: vho@metrohealth.org.
J Surg Res ; 256: 143-148, 2020 12.
Article in En | MEDLINE | ID: mdl-32707396
ABSTRACT

INTRODUCTION:

Historically, trauma patients have low adherence to recommended outpatient follow-up plans, which is crucial for improved long-term clinical outcomes. We sought to identify characteristics associated with nonadherence to recommended outpatient follow-up visits.

METHODS:

This is a single-center retrospective examination of inpatient trauma survivors admitted to a level 1 trauma center (March 2017-March 2018). Patients with known alternative follow-up were excluded. All outpatient visits within 1 y from the index admission were identified. The primary outcome was nonadherence, which was noted if a patient failed to follow-up for any specialty recommended in the discharge instructions. Factors for nonadherence studied included age, injury severity score, mechanism, length of stay, number of referrals made, and involvement with a Trauma Recovery Services program. Bivariate and logistic regression analyses were performed.

RESULTS:

A total of498 patients were identified (69% men, median age 43 y [range, 26-58 y], median injury severity score 14 [range, 9-19]). Among them, 240 (47%) were nonadherent. The most common specialties recommended were orthopedic surgery (56% referred, 19% nonadherent), trauma (54% referred, 35% nonadherent), and neurosurgery (127 referred, 35% nonadherent). Lowest levels of follow-up were seen for nonsurgical referrals. In adjusted analysis, a higher number of referrals made (odds ratio [OR], 2.45; 95% confidence interval [CI], 1.95-3.05) and older age (OR, 1.01; 95% CI, 1.00-1.02) were associated with nonadherence. Trauma Recovery Service participants and penetrating trauma patients were more likely to be adherent (OR, 0.60; 95% CI, 0.37-0.97).

CONCLUSIONS:

The largest contributor to nonadherence was the number of referrals made; patients who were referred to multiple specialists were more likely to be nonadherent. Peer support services may lower barriers to follow-up.
Subject(s)
Key words

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Patient Discharge / Referral and Consultation / Wounds and Injuries / Aftercare / No-Show Patients Type of study: Diagnostic_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limits: Adult / Female / Humans / Male / Middle aged Language: En Journal: J Surg Res Year: 2020 Type: Article

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Patient Discharge / Referral and Consultation / Wounds and Injuries / Aftercare / No-Show Patients Type of study: Diagnostic_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limits: Adult / Female / Humans / Male / Middle aged Language: En Journal: J Surg Res Year: 2020 Type: Article