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. AIMS: To describe trauma patient characteristics associated with completed follow-up after hospitalization and to compare relative rates of healthcare utilization across payor types. SETTING AND DESIGN: Single institution retrospective cohort study. MATERIALS AND 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. STATISTICAL ANALYSIS: 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). CONCLUSION: 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.