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Factors influencing follow-up adherence to an academic medical center after hand trauma
Rachel A Guest, MD, Paul McMillan, MD, Esha Reddy, BA, Chad Archdeacon, BA, Onyinyechukwu Otiocha, BA, Natasha Kejriwal, BA, Logan Lake, BA, Isaac Hale, BA; Matt Florczynski, MD
University of Cincinnati, Cincinnati, OH
Introduction: Hand trauma constitutes a significant volume of the caseload handled by emergency department (ED) providers and consulting services. Post-injury follow-up is an essential component of care for these injuries. As such, failure to attend follow-up appointments has been associated with numerous adverse outcomes. We hypothesized that socioeconomic factors, including area deprivation index (ADI) would influence follow-up adherence to the orthopedic hand clinic following hand and wrist trauma.
Materials and Methods: A matched, retrospective case-control study was performed to identify factors influencing follow-up adherence in patients with hand and wrist injuries. Patients presenting to the ED with injuries resulting in hand surgery consultation were identified by review of electronic medical records, resulting in 1,333 patients. 500 patients who followed up were matched with 500 patients who did not follow up using sex and age as matching variables. Independent samples t-tests were used to compare continuous variables, while Chi-squared tests were used to compare categorical variables. Binomial logistic regression analysis was performed to determine the effects of various factors on follow-up.
Results: There were 181 male patients and 319 female patients in each group. The average age was 43.2 years. There were significant differences in group composition by race (p = .003), insurance status (p = .001), diagnosis category (p < .001), presence of multi-system injury (p = .03), likelihood of surgery based on diagnosis (p < .001), and whether surgery was performed (p < .001) (Table I). Binomial regression modeling identified insurance status and diagnosis category to be significant predictors of follow-up (Table II). Patients with soft tissue injuries were less likely to follow up than those with closed fractures or dislocations (OR 0.09, p < .001). Compared to patients with commercial insurance, those with Medicaid coverage (OR 0.61, p = .024) or no insurance (OR 0.44, p = .014) were less likely to follow up. ADI and race were not found to be a significant predictors of follow-up status, although Black and Asian patients were significantly more likely to follow up than Caucasian patients. The model explained 52.2% of variance in follow-up with 80.5% sensitivity and 80.1% specificity.
Conclusions: Socioeconomic factors including insurance status and diagnosis category significantly affect follow-up adherence after hand trauma. Identification of patients at risk for loss to follow-up may allow clinicians to provide targeted counseling and address some of these barriers.
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