title: Local access to care programs increase trauma patient follow-up compliance.
abstract: BACKGROUND
  Inadequate follow-up of uninsured trauma patients after discharge remains a major challenge for trauma programs. Local access to care programs (LACPs) have been developed to improve access to health care to the uninsured. We hypothesized that enrollment in LACP would improve postdischarge follow-up of uninsured trauma patients.
  
  
  METHODS
  Study population consisted of 5,830 uninsured trauma patients from 2006 to 2011, treated at a large urban level-I trauma center. Patients with burn injuries, transfers to another acute-care facility, and those who died or who left against medical advice were excluded. Patients who enrolled in our LACP were compared with those who did not to determine the relationship between enrollment in LACP and postdischarge follow-up, while controlling for injury severity, demographics, and discharge disposition.
  
  
  RESULTS
  Patients in LACP were significantly more likely to schedule follow-up appointments after discharge (odds ratio = 1.78; 95% confidence interval, 1.51 to 2.10) and to comply with them (odds ratio = 2.44; 95% confidence interval, 1.98 to 2.99). However, 30-day readmission rates were similar in the 2 groups (1.1% vs 1.9%).
  
  
  CONCLUSIONS
  Enrollment in the LACP was associated with improved postdischarge follow-up but not readmissions.
authors.affiliation: Trauma Services, JPS Health Network, 1500 S. Main Street, Fort Worth, TX 76104, USA. Electronic address: toverton@jpshealth.org.
authors.forename: Tiffany L
authors.initials: TL
authors.lastname: Overton
authors.affiliation: Department of Surgery JPS Health Network, 1500 S. Main Street, Fort Worth, TX 76104, USA.
authors.forename: Shahid
authors.initials: S
authors.lastname: Shafi
authors.affiliation: Department of Surgery JPS Health Network, 1500 S. Main Street, Fort Worth, TX 76104, USA.
authors.forename: Rajesh R
authors.initials: RR
authors.lastname: Gandhi
mesh_terms: D000328:Adult; D003266:Continuity of Patient Care / Q000458:organization & administration*; D005260:Female; D005500:Follow-Up Studies; D006297:Health Services Accessibility / Q000458:organization & administration*; D006801:Humans; D008297:Male; D017057:Medically Uninsured; D008875:Middle Aged; D010349:Patient Compliance / Q000706:statistics & numerical data*; D010351:Patient Discharge; D010359:Patient Readmission / Q000706:statistics & numerical data; D018802:Patient-Centered Care / Q000458:organization & administration*; D015397:Program Evaluation; D012189:Retrospective Studies; D014193:Trauma Centers / Q000458:organization & administration*; D014947:Wounds and Injuries / Q000628:therapy*
keywords: Follow-up compliance; Local access to care programs; Patient centered medical home; Trauma; Uninsured