The American Journal of Surgery
Volume 199, Issue 3 , Pages 348-353, March 2010

Follow-up disparities after trauma: a real problem for outcomes research

Presented at the 52nd annual meeting of the Midwest Surgical Association, Lake Geneva, WI August 2–5, 2009.

  • William H. Leukhardt, M.D.

      Affiliations

    • MetroHealth Medical Center, Department of Surgery, Case Western Reserve University, School of Medicine, Room H939, Hamann Bldg, 2500 MetroHealth Drive, Cleveland, OH 44109-1998, USA
    • ,
  • Joseph F. Golob, M.D.

      Affiliations

    • MetroHealth Medical Center, Department of Surgery, Case Western Reserve University, School of Medicine, Room H939, Hamann Bldg, 2500 MetroHealth Drive, Cleveland, OH 44109-1998, USA
    • ,
  • Andy M. McCoy, B.S.

      Affiliations

    • MetroHealth Medical Center, Department of Surgery, Case Western Reserve University, School of Medicine, Room H939, Hamann Bldg, 2500 MetroHealth Drive, Cleveland, OH 44109-1998, USA
    • ,
  • Adam M.A. Fadlalla, Ph.D.

      Affiliations

    • Cleveland State University, Cleveland, OH, USA
    • ,
  • Mark A. Malangoni, M.D.

      Affiliations

    • MetroHealth Medical Center, Department of Surgery, Case Western Reserve University, School of Medicine, Room H939, Hamann Bldg, 2500 MetroHealth Drive, Cleveland, OH 44109-1998, USA
    • ,
  • Jeffrey A. Claridge, M.D., M.S.

      Affiliations

    • MetroHealth Medical Center, Department of Surgery, Case Western Reserve University, School of Medicine, Room H939, Hamann Bldg, 2500 MetroHealth Drive, Cleveland, OH 44109-1998, USA
    • Corresponding Author InformationCorresponding author. Tel.: +1-216-778-1005; fax: +1-216-778-1129

Received 26 July 2009; received in revised form 10 September 2009

Abstract 

Introduction

The objectives of this study were to (1) determine risk factors associated with failure to follow-up (FTF) after traumatic injury and (2) in those patients who do follow up, to determine if information within the electronic medical record (EMR) is an adequate data-collection tool for outcomes research.

Methods

A 6-year retrospective analysis was conducted on all admitted trauma patients using data from the trauma registry, National Death Index, 2000 Census Data, and the EMR. Bivariate and logistic regression analyses identified risk factors for FTF. A subgroup analysis evaluated the utility of using the EMR to determine basic functional outcomes (Glasgow outcome scale, diet, ambulation, and employment status).

Results

A total of 14,784 patients were discharged, and 61% had follow-up appointments. Lower income, higher poverty rates, and lower education were significantly (P < .05) associated with FTF. Logistic regression analysis (excluding census data) identified that older age, lower Injury Severity Score, less severe head injury, nonwhite race, blunt injury, death after discharge, zip code within 25 miles, and patients discharged to home independently predicted FTF after traumatic injury. A subgroup analysis of the EMR showed the inability to reliably determine functional outcomes.

Conclusions

There are several disparities related to follow-up after trauma. Furthermore, charting deficiencies, even with an EMR, highlight the weaknesses of data available for trauma outcomes research. Trauma process improvement programs could target patients at risk for not following up and use a structured electronic outpatient note.

Keywords: Trauma outcomes, Traumatic injury, Disparities, Outcomes research, Electronic medical record

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 Supported in part by grant number 1KL2RR024990 from the National Center for Research Resources (NCRR), a component of the National Institutes of Health (NIH), and NIH Road map for Medical Research. Its contents are solely the responsibility of the authors and do not necessarily represent the official view of NCRR or NIH.

PII: S0002-9610(09)00786-7

doi:10.1016/j.amjsurg.2009.09.021

The American Journal of Surgery
Volume 199, Issue 3 , Pages 348-353, March 2010

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