Outpatient care disparities in trauma patients discharged to jail: A propensity score matched study

Traumatically injured patients who are detained by law enforcement have variable disposition possibilities that may be unclear to providers. This creates difficulties in discharge planning, and may contribute to disparities in outpatient care. The objective of this study was to evaluate emergency department (ED) utilization, readmissions, and follow-up for traumatically injured patients discharged to jail compared to those discharged to home.

This was a retrospective review of traumatically injured patients at a Level 1 trauma center from 2015 - 2022. All patients discharged to jail were propensity matched 1:1 to a subset of patients discharged to home. The match was based on age, gender, race, mechanism of injury, and Injury Severity Score. The primary outcome was ED utilization within 60 days. Secondary outcomes were unplanned readmissions and attendance at trauma-related follow-up appointments. Outcomes were compared between the two groups.

There were 392 matched pairs. Patients discharged to jail were more likely to visit the ED compared to home patients (25 % vs 18 %, OR 1.46, 95 % CI 1.02 - 2.10, p = 0.030). There were no differences in unplanned readmissions (6 % vs 7 %, OR 0.86, 95 % CI 0.48 - 1.53, p = 0.579) between the two groups. Patients discharged to jail were more likely to visit the ED with concerns regarding obtaining their discharge prescriptions (19 % vs 1 %, p < 0.001), and 30 % (n = 7) of these patient readmissions were due to the jail not being able to accommodate their medical cares. A total of 28 % of patients discharged to jail had no trauma-related ambulatory follow-up compared to 15 % of home patients (OR 2.33, 95 % CI 1.59 - 3.49, p < 0.001).

Patients discharging to jail face fragmented transitions of care which creates barriers in outpatient healthcare engagement. They are more likely to visit the emergency department, and are less likely to have appropriate trauma related follow-up care. Targeted interventions are necessary to support this patient population to improve outpatient care after injury.