Continuity of firearm injury documentation from acute care to ambulatory care among Medicaid enrollees in Oregon

Am J Prev Med. 2025 Dec 26:108254. doi: 10.1016/j.amepre.2025.108254. Online ahead of print.

ABSTRACT

INTRODUCTION: Gunshot wounds (GSWs) are typically treated in acute care settings but longer-term sequelae are likely treated by ambulatory care providers. To understand if GSW treated in acute care settings are later documented in ambulatory care electronic health records (acEHR), acute care claims and acEHR data were linked. The primary objective was to determine the percentage of patients with a GSW diagnosis in their acEHR from all patients with both an acute care GSW diagnosis and an observed follow-up ambulatory care visit. The second objective was to identify demographic and clinical factors associated with a patient having a GSW diagnosis in their acEHR.

METHODS: This observational study linked Oregon Medicaid claims for acute GSW with acEHRs in OCHIN’s ADVANCE Data Warehouse from 2012 – 2022 for case identification. Patients with and without an International Classification of Diseases (ICD) code for GSW in their acEHR were characterized using descriptive statistics. Multivariable logistic regression conducted between 2024-2025 modeled predictors of GSW diagnosis in follow-up acEHR controlling for patient characteristics.

RESULTS: Only 34.3% of patients with a GSW event treated in an acute setting and with an observed ambulatory care visit had a GSW diagnosis in their acEHR. Time between acute GSW and follow-up ambulatory care, and the severity of the acute GSW injury were associated with having a GSW acEHR diagnosis. Patients identified as Black, non-Hispanic or Hispanic had higher odds of having a GSW acEHR diagnosis compared to White, non-Hispanic.

CONCLUSIONS: Most people who had a GSW treated in an acute care setting with a later ambulatory care visit did not have a GSW diagnosis in their acEHR, even though a GSW event can be relevant history for ambulatory care providers and patient care. Strategies to document prior GSW in ambulatory EHRs should be developed to support whole-person care in ambulatory settings.

PMID:41456620 | DOI:10.1016/j.amepre.2025.108254