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Providing a written appointment for followup care improves visit compliance among patients after hospital discharge

Increasingly shorter hospital stays have heightened the importance of followup medical visits after hospital discharge. Unfortunately, overburdened public hospitals and health care systems sometimes do not provide patients with written followup appointments at the time of discharge. Yet patients who are provided with written followup appointments are over three times more apt to make these medical visits than those without written appointments, concludes a study supported by the Agency for Healthcare Research and Quality (HS08093) and coauthored by Carolyn M. Clancy, M.D., Director of AHRQ's Center for Outcomes and Effectiveness Research.

Researchers led by Catarina I. Kiefe, Ph.D., M.D., of the University of Alabama at Birmingham, interviewed 372 patients admitted to a public hospital during hospitalization and after discharge, searched the hospital's electronic databases, and reviewed medical charts to identify factors related to compliance with postdischarge medical visits. Of the 344 patients who were discharged from the hospital with a followup appointment, 64 percent kept their first appointment. Appointment-keeping was directly associated with receiving a written appointment at the time of discharge. The patients were predominantly young (average age of 48), black, and uninsured.

The most common single reason given by patients who missed their appointments was not knowing about the appointment. Even though hospital policy mandated that patients receive written confirmation of followup appointments at the time of discharge, this did not happen in 19 percent of cases. Another disturbing finding was the 14 percent no-show rate among those who had an appointment scheduled at the time of hospital discharge. Face-to-face reinforcement of the importance of keeping appointments or telephone reminders preceding them might further increase compliance with posthospitalization followup. As noted by the researchers, facilitating access to followup appointments may decrease hospital readmissions.

More details are in "Compliance with post-hospitalization follow-up visits: Rationing by inconvenience?" by Dr. Kiefe, Gustavo Heudebert, M.D., J. Brent Box, M.D., and others, in the Autumn 1999 Ethnicity and Disease 9, pp. 387-395. Reprints (AHRQ Publication No. 00-R015) are available from the AHRQ Publications Clearinghouse.

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