If You Book It, Will They Come? Attendance at Postdischarge Follow-Up Visits Scheduled by Inpatient Providers
BACKGROUND: Postdischarge follow-up visits (PDFVs) are widely recommended to improve inpatient-outpatient transitions of care.
OBJECTIVE: To measure PDFV attendance rates. DESIGN: Observational cohort study.
SETTING: Medical units at an academic quaternary-care hospital and its affiliated outpatient clinics.
PATIENTS: Adult patients hospitalized between April 2014 and March 2015 for whom at least 1 PDFV with our health system was scheduled. Exclusion criteria included nonprovider visits, visits cancelled before discharge, nonaccepted health insurance, and visits scheduled for deceased patients.
MEASUREMENTS: The study outcome was the incidence of PDFVs resulting in no-shows or same-day cancellations (NS/SDCs).
RESULTS: Of all hospitalizations, 6136 (52%) with 9258 PDFVs were analyzed. Twenty-five percent of PDFVs were NS/SDCs, 23% were cancelled before the visit, and 52% were attended as scheduled. In multivariable regression models, NS/SDC risk factors included black race (odds ratio [OR] 1.94, 95% confidence interval [CI], 1.63-2.32), longer lengths of stay (hospitalizations ≥15 days: OR 1.51, 95% CI, 1.22-1.88), and discharge to facility (OR 2.10, 95% CI, 1.70-2.60). Conversely, NS/SDC visits were less likely with advancing age (age ≥65 years: OR 0.39, 95% CI, 0.31-0.49) and driving distance (highest quartile: OR 0.65, 95% CI, 0.52-0.81). Primary care visits had higher NS/SDC rates (OR 2.62, 95% CI, 2.03-3.38) than oncologic visits. The time interval between discharge and PDFV was not associated with NS/SDC rates.
CONCLUSIONS: PDFVs were scheduled for more than half of hospitalizations, but 25% resulted in NS/SDCs. New strategies are needed to improve PDFV attendance. Journal of Hospital Medicine 2017;12:618-625. © 2017 Society of Hospital Medicine
CONCLUSION
Given national efforts to enhance postdischarge transitions of care, we aimed to analyze attendance at provider-scheduled PDFV appointments. Our finding that 25% of PDFVs resulted in NS/SDCs raises both questions and opportunities for inpatient and outpatient providers. Further research is needed to understand why so many patients miss their PDFVs, and we should work as a field to develop creative solutions to improve PDFV scheduling and attendance.
Acknowledgments
The authors acknowledge Marie Synnestvedt, PhD, and Manik Chhabra, MD, for their assistance with data gathering and statistical analysis. They also acknowledge Allison DeKosky, MD, Michael Serpa, BS, Michael McFall, and Scott Schlegel, MBA, for their assistance with researching this topic. They did not receive external compensation for their assistance outside of their usual salary support.
DISCLOSURE
Nothing to report.
