Stone ME Jr, Marsh J, Cucuzzo J, et al.. Factors associated with trauma clinic follow-up compliance after discharge: experience at an urban Level I trauma center
ABSTRACT Disparities in access to postdischarge services for trauma patients exist, and clinic follow-up remains an important avenue to ensure initial and continued access to postdischarge services. In addition, follow-up is vital to rigorous long-term trauma outcomes research. However, there is a relative paucity of literature specifically addressing clinic follow-up. The purposes of this study were to elucidate factors associated with clinic follow-up compliance and noncompliance after discharge from an urban Level I trauma center and to confirm the prevailing notion that follow-up in trauma clinic is poor.
Our trauma registry was queried for all trauma service discharges of patients 18 years and older for a 2-year period. Patients with incomplete information were excluded. Demographic data such as race/ethnicity and insurance status were collected on all patients. Primary outcome was defined as trauma clinic follow-up within 4 weeks after discharge. Patients compliant with follow-up were compared with noncompliant patients.
After exclusion criteria were applied, there were 1,818 discharges included in the analysis, with 564 (31%) complying with follow-up (p < 0.001). Factors significantly associated with follow-up noncompliance included patients older than 35 years, white race, Medicaid/Medicare payers, blunt mechanism, extended hospital length of stay, and discharge to rehabilitation facilities. No insurance, penetrating mechanism, short hospital stay, discharge to home, and weekend discharge were all significantly associated with follow-up compliance. Discharge on weekends and to home were independent predictors of compliance, whereas, Medicaid/Medicare insurance status and operative intervention were independent predictors of noncompliance.
This study indentifies factors associated with trauma clinic follow-up compliance and confirms the notion that trauma clinic follow-up compliance at an urban Level I trauma center is alarmingly low. These findings may serve as targets to improve follow-up, thereby improving trauma outcomes research and long-term outcomes. Consequently, clinic follow-up compliance warrants further study and consideration as an essential trauma registry datum.
Prognostic study, level III.
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ABSTRACT: 1. To determine whether negative pressure dressings (NPD) are superior to conventional compressive dressings (CD) for split-thickness skin grafts (STSG) placed on healthy, low-risk wounds. 2. To determine cost difference of NPD versus CD. Retrospective SETTING:: Level I Trauma Center PATIENTS/PARTICIPANTS:: 195 traumatic wounds treated with STSG. Patients were assigned outcomes based on postoperative documentation: completely healed, incompletely healed (small areas of graft necrosis), failed, or lost to follow-up. The costs associated with the each dressing type were documented. 35 of 195 STSG were lost to follow-up, leaving N=120 STSG-NPD, N=40 STSG-CD. Of the remaining 120 STSG treated with NPD, 91 completely healed, 23 incompletely healed, and 6 failed. Of the 40 STSG treated with a compressive dressing, 37 completely healed, 1 incompletely healed, and 2 failed. Patients treated with compressive dressings had higher likelihood of healing relative to the NPD (p = 0.018). Analyzing the outcomes as failed versus "not failed" revealed no significant difference between the groups (p = 1.00). There were more smokers in the compression dressing group (p=0.022). In this series, the mean cost associated with NPD compared to compressive dressing was $2,370 more per patient. There is a high rate of successful healing of split-thickness skin grafts for traumatic extremity wounds regardless of dressing used. The increased cost of NPD is not justified in wounds that are at low risk for STSG failure. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.Journal of Orthopaedic Trauma 12/2014; 29(7). DOI:10.1097/BOT.0000000000000259 · 1.54 Impact Factor