Outpatient follow-up after traumatic injury: Challenges and opportunities.
BACKGROUND
It has been shown that rates of ambulatory follow-up after traumatic injury are not optimal, but the association with insurance status has not been studied.


OBJECTIVE
To describe trauma patient characteristics associated with completed follow-up after hospitalization and to compare relative rates of healthcare utilization across payor types.


METHODS
Single institution retrospective cohort study.


METHODS
We compared patient demographics and healthcare utilization behavior after discharge among trauma patients between April 1, 2005 and April 1, 2010. Our primary outcome of interest was outpatient provider contact within 2 months of discharge.


METHODS
Multivariate logistic regression was used to determine the association between characteristics including insurance status and subsequent ambulatory and acute care.


RESULTS
We reviewed the records of 2906 sequential trauma patients. Patients with Medicaid and those without insurance were significantly less likely to complete scheduled outpatient follow-up within 2 months, compared to those with private insurance (Medicaid, OR 0.67, 95% CI 0.51-0.88; uninsured, OR 0.29, 95% CI 0.23-0.36). Uninsured and Medicaid patients were twice as likely as privately insured patients to visit the Emergency Department (ED) for any reason after discharge (uninsured patients (Medicaid, OR 2.6, 95% CI 1.50-4.53; uninsured, OR 2.10, 94% CI 1.31-3.36).


CONCLUSIONS
We found marked differences between patients in scheduled outpatient follow-up and ED utilization after injury associated with insurance status; however, Medicaid seemed to obviate some of this disparity. Medicaid expansion may improve outpatient follow-up and affect patient outcome disparities after injury.
Department of Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, USA.
Luke
L
Hansen
Department of Surgery, Albert Einstein University, New York, USA.
Aisha
A
Shaheen
Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, USA.
Marie
M
Crandall
Follow-up; health care costs; re-injury; trauma