Care Discontinuity in Geriatric Trauma: Can Long-Term Outcomes Better Measure Its Effect?
*Manuel Castillo-Angeles MD, MPH, *Cheryl Zogg MD PhD, *Molly P. Jarman PhD, *James C. Etheridge MD, *Christine Wu MD, Reza Askari MD, *Stephanie L. Nitzschke MD, Ali Salim MD, *Zara Cooper MD, Joaquim Havens
Surgery, Brigham and Women's Hospital, Brookline, MA
Background: Care discontinuity, defined as readmission to a non-index hospital, has been associated with worse outcomes for common medical conditions and surgical procedures. However, prior studies focused on short-term outcomes have shown conflicting results within the trauma population. Recently, the adequacy of in-hospital mortality to measure the quality of older adult trauma care has been challenged, followed by a call to use new post-discharge quality metrics measured up to a year after injury. Our goal was to determine the impact of care discontinuity on older trauma patients using these long-term outcomes.
Study Design: We performed a retrospective analysis of Medicare inpatient claims (2014-2015) of geriatric trauma patients. Care discontinuity was defined as readmission within 30 days to a non-index hospital. For our outcomes, we used two of the most important new drivers of geriatric trauma quality benchmarking: patients’ average number of healthy days at home (HADH) within 365 days and 365-day mortality. Multivariate logistic regression analysis was performed to identify the association between care discontinuity and our outcomes.
Results: 772,109 geriatric trauma patients were included. Mean age was 82.15 (SD 8.49), 68.3% were female, 91.6% were white, and mean ISS was 9.49 (SD 5.80). 21,743 (2.82%) were readmitted within 30 days of discharge. Of these, 34% were readmitted to a non-index hospital.
After adjusting for patient- and hospital-level characteristics, care discontinuity was not associated with 365-day mortality (OR 0.96, 95% Confidence Interval [CI] 0.90–1.02) or with patients’ average number of HDAH within 365 days (Coefficient -1.10, 95% CI -3.20–1.01).
Conclusions: Using newly proposed geriatric trauma quality metrics, this study showed that care discontinuity was not associated with worse long-term outcomes. However, standardized trauma care and recent implementation of geriatric pathways have the potential to increase the impact of care continuity for geriatric trauma patients.
Back to 2024 Posters