Fragmentation of Care After Admissions for Burn: An Analysis of the National Readmissions Database

Burn patients require complex longitudinal care guided by a team with specific clinical expertise. Burn patients are at increased need for readmission, which may result in Fragmentation of care (readmission to hospitals other than the index hospital), that can lead to increases in mortality, length of stay, and financial burden. In the already-complex burn patient, negative effects of care fragmentation may be magnified. We hypothesized that specific patient and demographic factors would be associated with burn readmissions and fragmentation of care.

Utilizing the Nationwide Readmissions database, we identified patients admitted between January and September 2017 with a principal diagnosis of burn readmitted to any hospital within 90 d of index discharge. Demographics, total burn surface area, Elixhauser comorbidities, and index discharge disposition were collected. Primary outcome was readmission to the same hospital as the index admission. Penalized multivariable logistic regression assessed factors associated with index hospital readmission.

Of 9987 burn patients who survived an index burn admission, 1082 (10.8%) were readmitted. Approximately half (51.6%, n = 558) of readmissions occurred at the index hospital. Factors associated with readmission to the same hospital were disposition to home with home health care (odds ratio: 1.42 [1.02-1.96], P = 0.037), private insurance (odds ratio: 1.63 [1.07-2.49], P = 0.022), and ZIP code income quartile >$74,000 (OR 1.87 [1.26-2.78], P = 0.002).

Disposition home with home health care, private insurance, and a ZIP code income quartile greater than $74,000 were associated with a lower odds of having fragmentated care. Our data suggest that fragmentation of care may be potentiating a disparity for lower-income burn patients.