Lack of Primary Care Continuity Predicts Readmission Risk Among Socially Vulnerable Trauma Populations.

Abstract

IntroductionEarly unplanned trauma readmission (UR-30) is not well-understood. Social vulnerability indices (SVIs) and primary care access were postulated as contributing factors to discharge outcomes.MethodsRetrospective propensity-matched analysis at a Level I Trauma Center compared readmitted patients (UR-30, n = 85) to those without (NoReadmission-30, n = 85). Established PCP relationship and five social vulnerability indices (SVIs) were evaluated.Results170 total patients had average age 56.6, 71.8% male, and 95.3% Caucasian. Average ISS = 9. Average LOS was 6.44 ± 6.71 days. LOS was longer in readmissions (5 vs 3 days, P = 0.03). UR-30 had 2.908X more patients with >3 comorbidities (P < 0.001). No SVI (CDC SVI Quality, ARC, FORHP, CBSA, and PLACES; P = 0.303, 0.882, 0.916, 0.721, and 1.000, respectively) was significant. 49.4% of UR-30 and 72.9% of NoReadmission-30 patients had a documented PCP, conferring a 0.371 [0.137-1.007] times lower odds of readmission (P = 0.047).ConclusionOur findings suggest that lack of PCP access/continuity of routine medical care contributes to UR-30 among trauma patients when high levels of social vulnerability are routinely present. Social vulnerability indices did not identify readmission risk in this predominantly rural, underserved patient population.