From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine in St. Louis; and the Department of Plastic and Reconstructive Surgery, The Ohio State University.
Plast Reconstr Surg. 2021 Mar 1;147(3):545-554. doi: 10.1097/PRS.0000000000007687.
Hand-injured patients seen in the emergency department can often be followed as outpatients for definitive care and rehabilitation. Many face barriers to continuing care in the outpatient setting that impact quality of care delivery. The authors aimed to evaluate patterns of outpatient follow-up after initial emergency department evaluation of traumatic hand injuries, identify factors associated with poor follow-up, and suggest areas for improvement.
In this retrospective cohort study, the authors reviewed records of adult patients with acute hand injuries referred for outpatient follow-up after initial plastic surgery consultation in the emergency department of a single urban Level I trauma center over a 12-month period (n = 300). Patients were grouped by insurance (i.e., no insurance, Medicaid, Medicare, or private). Outcomes included completion of outpatient follow-up, hand therapy participation, and emergency department return visits.
Factors significantly associated with failure to follow up included male sex (OR, 3.58; 95 percent CI, 1.57 to 8.16), uninsured status (OR, 3.47; 95 percent CI, 1.48 to 8.16), Medicaid insurance (OR, 4.46; 95 percent CI, 1.31 to 15.25), and lack of a driver's license (OR, 3.35; 95 percent CI, 1.53 to 7.34). Hand therapy attendance and unexpected emergency department return visits also varied significantly by insurance type (p < 0.001).
There is a significant disparity in the use of outpatient care after emergency department visits for acute hand injuries. Uninsured and Medicaid-insured patients are significantly less likely to initiate recommended hand specialty follow-up, and significantly less likely to complete follow-up even when established with an outpatient clinic. Future research should evaluate targeted interventions for at-risk patients.
在急诊科就诊的手部受伤患者通常可以接受门诊治疗和康复。许多患者在门诊继续治疗时面临障碍，影响了护理质量。作者旨在评估创伤性手部损伤患者在急诊初步评估后的门诊随访模式，确定与随访不良相关的因素，并提出改进建议。
在这项回顾性队列研究中，作者对在单家城市一级创伤中心急诊科接受整形外科咨询后被转诊至门诊进行随访的 300 例成人急性手部损伤患者的记录进行了回顾。患者根据保险类型（即无保险、医疗补助、医疗保险或私人保险）进行分组。结局包括完成门诊随访、手部治疗参与情况和急诊科复诊。
与未能随访相关的显著因素包括男性（OR，3.58；95%CI，1.57 至 8.16）、无保险状态（OR，3.47；95%CI，1.48 至 8.16）、医疗补助保险（OR，4.46；95%CI，1.31 至 15.25）和无驾照（OR，3.35；95%CI，1.53 至 7.34）。手部治疗的参与率和意外急诊科复诊率也因保险类型而异（p < 0.001）。
在急诊科就诊后，门诊护理的使用存在显著差异。未参保和医疗补助保险的患者明显不太可能开始接受手部专科推荐的随访，即使在建立了门诊诊所的情况下，他们也明显不太可能完成随访。未来的研究应评估针对高危患者的靶向干预措施。
