Determinants of Follow-Up Adherence Among Hand Trauma Patients at an Academic Medical Center

The purpose of this study was to identify demographic, clinical, and socioeconomic factors associated with follow-up adherence among hand trauma patients at an urban level I trauma center.

A retrospective cohort study was conducted using electronic health records of adult patients presenting with hand trauma between June 2022 and March 2024. A 1:1 age- and sex-matched case-control sample of 1000 patients was created, divided by follow-up status. Variables included race, insurance type, injury category, likelihood of surgery, surgical treatment, multi-system injury, and Area Deprivation Index (ADI). Logistic regression was used to identify predictors of follow-up.

Insurance status and injury type were independently associated with follow-up. Patients with Medicaid (odds ratio [OR] 0.61, P = .024) or self-pay (OR 0.44, P = .014) were less likely to return than those with commercial insurance. Patients with soft-tissue injuries were significantly less likely to follow up than those with closed fractures or dislocations (OR 0.09, P < .001). Race and ADI were not independently predictive. The model demonstrated strong performance with an area under the curve (AUC) of 0.863.

Insurance type and injury severity were significant predictors of follow-up adherence. Broader demographic and neighborhood-level socioeconomic measures were not independently associated. These findings may inform targeted strategies to reduce disparities in postinjury care.