The Unhoused Burn Population: An Alarming Increase of Leaving Against Medical Advice

Area of Science:

• Medical research
• Public health
• Burn care

Background:

• Unhoused burn patients (UBPs) historically face poorer health outcomes and higher rates of leaving against medical advice (AMA).
• The COVID-19 pandemic significantly strained healthcare systems, potentially worsening outcomes for all burn patients.

Purpose of the Study:

• To investigate the impact of the COVID-19 pandemic on treatment adherence, specifically the rate of leaving AMA, among unhoused burn patients.
• To compare AMA discharge rates for unhoused burn patients before and during the COVID-19 pandemic.

Main Methods:

• Retrospective chart analysis of patients admitted to a regional burn center from June 2015 to January 2023.
• Patients were divided into pre-COVID-19 (p-CV) and during COVID-19 (CV) cohorts, with March 1, 2020, as the dividing date.
• Outcomes analyzed included leaving AMA and 30-day readmission, focusing on 385 unhoused burn patients.

Main Results:

• Unhoused burn patients were significantly more likely to leave AMA during the CV period (22.6%) compared to the p-CV period (7.5%) (P < .001).
• Housed burn patients did not show an increased rate of AMA discharges during the same period.
• The study identified a specific increase in AMA discharges exclusively among unhoused burn patients during the COVID-19 pandemic.

Conclusions:

• The COVID-19 pandemic exacerbated the trend of unhoused burn patients leaving treatment AMA.
• Findings suggest that this vulnerable population may be receiving inadequate care in the post-COVID era.
• Further research is crucial to understand the causes of increased AMA discharges and develop interventions for unhoused burn patients.