Background
Aside from risk of recurrent injury and death, gun violence survivors (GVS) are also at high risk of an array of adverse mental and physical health outcomes. Post-traumatic stress disorder (PTSD) affects up to 20% of trauma patients post-injury.1 2 Individuals who survive a gunshot wound in particular are at even higher risk of developing PTSD when compared with non-assaultive mechanisms of injury (e.g., motor vehicle crash survivors).3 Prior research has identified that GVS are also at high risk of developing chronic pain, increased alcohol and substance use, decreased physical function, and overall worsened physical and mental health-related quality of life.3 4 These outcomes impact the daily lives of GVS and negatively impact interpersonal relationships through increased irritability and hypervigilance, avoidance of external reminders, sleep disturbance, and intentional withdrawal and isolation, which further hinder optimal recovery and support.5
Clinical follow-up represents a crucial opportunity to re-engage with GVS and to facilitate positive health outcomes through an increase in access to care. However, in this population, loss to follow-up complicates the transition to outpatient care. Loss to follow-up rates have been reported as high as 69% in this population, and firearm injury has been shown to be an independent predictor for loss to follow-up.6 Current discharge models for firearm-related injuries and trauma care are generally inconsistent and unstandardized across trauma centers.7 These models fail to account for the spectrum and severity of physical, psychological, and social needs that GVS face in recovery. Overall, the transition of care that occurs when GVS are discharged from the hospital setting is plagued with poor communication, varied access to resources, and insufficient referrals—especially to psychological services.8
Some hospital systems have attempted to address these concerns by developing programs that focus on the unique social and psychological needs of trauma patients, in addition to addressing physical recovery.9–11 Although advances have been made in making follow-up care increasingly interdisciplinary and patient-centered, these improvements are not tailored to the unique needs of GVS. The Trauma Quality of Life (TQoL) Clinic was developed in 2018 in response to the specific medical and psychosocial needs of the overall trauma patient population, given the significant risk of future morbidity. After a feasibility trial that demonstrated a reduction in no shows and an increase in access to care in comparison with standard of care,7 the TQoL Clinic was reimagined and formally established specifically for GVS in 2020. The decision was made to focus specifically on this patient population due to their higher risk for poor patient-reported outcomes and complex psychosocial needs. At the initial appointment, patients see a trauma provider, psychologist, physical therapist, and social worker specialized in trauma care. A hospital-based violence interrupter was added to the treatment team to complement the multidisciplinary team approach to follow-up care and further address the safety and psychosocial needs for GVS. This article aimed to provide a clinical description of the patients seen in TQoL Clinic and the emergency healthcare services used prior to their first appointment. A secondary aim was to describe subsequent referrals placed during clinic, as well as the rate of attendance for those referrals.