title: Factors associated with trauma clinic follow-up compliance after discharge: experience at an urban Level I trauma center.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
  
  
  METHODS
  Prognostic study, level III.
authors.affiliation: From the Jacobi Medical Center/Albert Einstein College of Medicine, Bronx, New York.
authors.forename: Melvin E
authors.initials: ME
authors.lastname: Stone
authors.forename: Jeremy
authors.initials: J
authors.lastname: Marsh
authors.forename: Janet
authors.initials: J
authors.lastname: Cucuzzo
authors.forename: Srinivas H
authors.initials: SH
authors.lastname: Reddy
authors.forename: Sheldon
authors.initials: S
authors.lastname: Teperman
authors.forename: Jody M
authors.initials: JM
authors.lastname: Kaban
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006786:Hospitals, Urban / Q000706:statistics & numerical data; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data; D007348:Insurance, Health; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009519:New York City; D010349:Patient Compliance / Q000706:statistics & numerical data*; D010351:Patient Discharge / Q000706:statistics & numerical data*; D014193:Trauma Centers / Q000706:statistics & numerical data*; D014947:Wounds and Injuries / Q000628:therapy*; D014949:Wounds, Nonpenetrating / Q000628:therapy; D055815:Young Adult