Hubbard Elizabeth W, Rathjen Karl E, Elliott Marilyn, Wimberly Robert L, Riccio Anthony I
Department of Orthopaedic Surgery, Duke University Medical Center, Lenox Baker Children's Hospital, Durham, North Carolina.
Department of Orthopaedic Surgery, Texas Scottish Rite Hospital for Children and Children's Medical Center of Dallas.
J Pediatr Orthop B. 2022 Jan 1;31(1):25-30. doi: 10.1097/BPB.0000000000000824.
This study aims to identify characteristics associated with poor appointment adherence after surgical stabilization of supracondylar humerus fractures (SCHFX) in children. A retrospective review of 560 consecutive, surgically managed patients with SCHFX from 2010 to 2015 was performed. One missed follow-up appointment was classified as 'low adherence', whereas missing two or more appointments was classified as 'very low adherence'. Demographics, insurance status, estimated family income and distance from clinic were analyzed to identify differences in variables between adherent and low-adherent groups. Of 560, 121 (21.8%) missed one follow-up visit and 39/560 (7.1%) missed more than two visits. Age, gender, distance traveled, insurance status and primary language were nonpredictive. Estimated income <$50 000 was associated with a >200% increase in low adherence vs patients with estimated income >$50 000 (9.3 vs 3.8%; P = 0.012). African American patients had significantly lower adherence vs patients of other races (47.5 vs 19.6%; P < 0.0001). Ethnicity remained the only significant factor correlated to adherence after multivariate analysis. African Americans were three times more likely demonstrate low adherence (P = 0.0014). Ethnicity and estimated income <$50 000 were predictors of missing two or more visits. African American patients were four times more likely to miss two or more visits [odds ratio (OR), 4.17; P = 0.0026] than others; estimated income <$50 000 was associated with a two-fold increase in missing two or more visits (OR, 2.33; P = 0.035). By identifying at-risk patient populations, healthcare systems can adopt strategies to remove barriers of accessing follow-up care.
本研究旨在确定与儿童肱骨髁上骨折（SCHFX）手术稳定治疗后预约依从性差相关的特征。对2010年至2015年连续560例接受手术治疗的SCHFX患者进行了回顾性研究。一次错过随访预约被归类为“低依从性”，而错过两次或更多预约被归类为“极低依从性”。分析了人口统计学、保险状况、估计家庭收入和距诊所的距离，以确定依从组和低依从组之间变量的差异。在560例患者中，121例（21.8%）错过一次随访，39例（7.1%）错过两次以上随访。年龄、性别、行程距离、保险状况和主要语言无预测性。估计收入<$50 000的患者与估计收入>$50 000的患者相比，低依从性增加>200%（9.3%对3.8%；P = 0.012）。非裔美国患者的依从性明显低于其他种族患者（47.5%对19.6%；P < 0.0001）。多变量分析后，种族仍然是与依从性相关的唯一显著因素。非裔美国人表现出低依从性的可能性是其他种族的三倍（P = 0.0014）。种族和估计收入<$50 000是错过两次或更多次就诊的预测因素。非裔美国患者错过两次或更多次就诊的可能性是其他患者的四倍[比值比（OR），4.17；P = 0.0026]；估计收入<$50 000与错过两次或更多次就诊增加两倍相关（OR，2.33；P = 0.035）。通过识别高危患者群体，医疗系统可以采取策略消除获得后续护理的障碍。
