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

Author:

Speiser Noah1ORCID,Donohue Sean J12ORCID,Pickering Trevor A3ORCID,Pham Christopher4ORCID,Johnson Maxwell4,Gillenwater Timothy Justin4ORCID,Yenikomshian Haig A4ORCID

Affiliation:

1. Keck School of Medicine, University of Southern California , Los Angeles, CA 90007 , USA

2. Department of Surgery, Los Angeles General Medical Center , Los Angeles, CA 90033 , USA

3. Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California , Los Angeles, CA 90007 , USA

4. Division of Plastic Surgery, Keck School of Medicine, University of Southern California , Los Angeles, CA 90007 , USA

Abstract

Abstract Unhoused burn patients (UBPs) have historically been more likely to leave against medical advice (AMA) and suffer worse health outcomes than the general population. The coronavirus disease 2019 (COVID-19) pandemic created a major strain on the health care system, resulting in worse overall health outcomes for burn patients. We sought to investigate how COVID-19 impacted treatment for UBP, specifically the rate of leaving AMA. We conducted a retrospective chart analysis of patients admitted to a regional burn center between June 2015 and January 2023. March 1, 2020 was used as a cut point to separate the cohorts into patients seen pre-COVID-19 (p-CV) and during COVID-19 (CV). Outcomes included leaving treatment AMA and readmission within 30 days. In total, 385 patients met criteria for being unhoused and were included in our analytic sample, of which 199 were in the p-CV cohort and 186 in the CV cohort. UBP were significantly more likely to leave AMA during CV compared to p-CV (22.6% vs 7.5%, P < .001). Housed burn patients did not experience an increase in discharges AMA during this time period. The COVID-19 pandemic resulted in an increase in discharges AMA among unhoused patients only. While the etiology is unclear, our findings suggest that this vulnerable patient population is receiving inadequate care post-COVID. Future research should determine the driving force behind these increases and identify early interventions to mitigate them.

Funder

National Institute on Disability, Independent Living, and Rehabilitation Research

Administration for Community Living

National Center for Advancing Translational Science

U.S. National Institutes of Health

Publisher

Oxford University Press (OUP)

Reference26 articles.

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