582 Predictors of Care Discontinuity in a National Sample of Burn Patients

TL;DR

This study identifies factors that predict care discontinuity in burn patients, which can lead to better strategies for improving continuity of care.

Contribution

The study provides new insights into demographic and clinical predictors of care discontinuity in a national sample of burn patients.

Findings

Older age, female sex, and higher Total Body Surface Area burned are associated with increased care discontinuity.

Racial minorities and longer hospital stays are linked to decreased risk of care discontinuity.

Care discontinuity is relatively uncommon but influenced by patient-specific factors.

Abstract

Continuity of care has become a widely accepted metric of quality of care. It has been shown that care discontinuity is associated with worse outcomes in the surgical and burn populations. However, there is a scarcity of data on factors leading to this discontinuity. The aim of this study was to determine predictors of care discontinuity in a national sample of burn patients.

This was a retrospective study using a multicenter longitudinal database from 1996 to 2021. All adult burn patients from participating sites were included. The main outcome was care discontinuity. This was defined by having therapy or burn-related surgeries at non-index (different hospital than the one for the original admission). Multivariable logistic regression was used to examine the association between multiple demographic and clinical factors and care discontinuity.

A total of 4,167 burn patients were included. Mean age was 43.36 (SD 15.85) years, 73% were male and 70% were white. 505 (12.1%) burn patients reported having therapy or burn-related surgeries at a non-index hospital. After adjusted analysis, we identified several predictors of care discontinuity in the burn population. Older age (Odds Ratio [OR] 1.02, 95% Confidence Interval [CI] 1.01 – 1.03), female sex (OR 1.28, 95% CI 1.01 – 1.62), Total Body Surface Area burned (OR 1.01, 95% CI 1.01 – 1.02) and number of trips to the operating room (OR 1.26, 95% CI 1.19 – 1.32) were associated with higher odds of being readmitted to a non-index hospital. However, racial minority (OR 0.65, 95% CI 0.49 – 0.88) and a longer hospital stay (OR 0.99, 95% CI 0.98 – 0.99) were associated with a lower risk of care discontinuity.

Care discontinuity was not that common in the burn population, and it is mainly driven by patient demographic and burn-specific clinical characteristics. Further research should focus on developing strategies targeted to address these disparities in order to improve continuity of care in the burn population.

Understanding the predictors of care discontinuity in the burn population may help clinicians develop strategies to address these disparities, decrease care fragmentation and subsequently have better outcomes.