101 Homeless Status, Distance from Clinic, and Substance Dependence Associated with Low Follow-Up Rates for Burn-Injured Survey Respondents

Solomon, Eve A; Phelan, Elizabeth; Tumbaga, Lilia G; Karashchuk, Irina P; Greenhalgh, David G; Sen, Soman; Palmieri, Tina L; Romanowski, Kathleen S

INTRODUCTION: Over 25% of burn-injured patients at our institution never attended a follow-up appointment. A quality-improvement discharge survey (QIS) identified potential barriers to follow-up as distance from the clinic, transportation, and time off work. This study compares follow-up rates before and after the QIS was administered and correlates them with patients’ self-identified barriers. METHODS: Following IRB approval, a retrospective chart review was conducted using electronic medical records of adult burn-center admits who responded to the QIS and were discharged between September 2019 and July 2020. Controls were burn-center admits discharged from 2016–2018, prior to the survey period. Exclusions included patients with non-burn injuries, and those who died in the hospital were transferred to another hospital, did not require follow-up, or followed up elsewhere. Data analysis was conducted using chi-square, t-test, and logistic regression models. RESULTS: The post-survey group includes 272 patients (mean age 47 ± 16.8, 201 males (73.6%), mean burn size (TBSA) of 9.3% ± 9.6%). The pre-survey control group includes 878 patients (mean age 45.1 ± 16.8 years, 646 males (73.6%), mean burn size (TBSA) 10.16 ± 11.7%). Compared to the pre-survey group, post-survey patients had a lower frequency of missed appointments (MA) (47.3% post vs. 56% pre), but worse overall follow-up rates (63.7% post vs. 74.5% pre). Per multivariate analysis, different factors were associated with follow-up and MA in the two groups (Table 1). Rates of follow-up and MA were not significantly different before and after the onset of the Covid-19 pandemic. CONCLUSIONS: Patients who were surveyed to identify barriers to follow-up had fewer missed appointments but worse overall follow-up rates. Patients fail to follow up due to homelessness, substance dependence, and distance to the hospital. These findings are consistent with patients’ self-identified barriers to follow-up in a QI survey. [Image: see text]