Background: Post-discharge appointment follow-up is recognized as a key intervention in reducing readmissions. Studies show that having a follow-up visit can reduce readmission risk, particularly for patients at higher risk for readmission. [1] Among Medicaid patients, primary care physician (PCP) follow-up within seven days of discharge was associated with reduced 30 and 90-day readmissions. [2] In another study, having a PCP follow-up visit reduced likelihood of readmissions by 10-fold. [3] In patients with sickle cell disease (SCD), outpatient follow-up reduced 14 and 30-day readmissions. [4] Further, there may be additional benefit when the patient attends the appointment, as clinic non-adherence carries higher odds of admissions and readmissions in the SCD population. [5] Clinic non-adherence in patients with congenital heart disease is an independent risk factor for death, despite control for complexity of disease and socioeconomic status. [6]The Med-Peds (MP) service line within hospital medicine cares for young adults with chronic childhood-onset disease (CCOD). Baseline 30-day readmission rate for this population is approximately 33%. We aimed to assess post-discharge follow-up appointment scheduling and adherence in our patient population to inform future quality improvement efforts towards reducing readmissions.
Methods: We analyzed patients discharged from the MP service line from January through August 2020. These patients were then sorted by diagnoses, of which the four most common diagnoses were then analyzed: sickle cell disease (SCD), type 1 diabetes (T1DM), inflammatory bowel disease (IBD), and lupus (SLE). Post-discharge PCP and specialty appointments within 30 days of discharge were assessed.
Results: During the study period, there were 103 discharges of patients with SCD (56%), T1DM (20%), IBD (14%), and SLE (13%). All patients had a follow-up appointment within 30 days scheduled at the time of discharge. 57% were scheduled with a PCP appointment and 85% were scheduled with one or more specialty appointment. Appointment adherence rate for scheduled primary care appointments was 44%. Appointment adherence rate for scheduled specialty appointments was 75%. For patients with SCD, 43% had PCP appointments made and 44% attended those appointments. There were a higher percentage of patients attending their specialty appointments with heme (66%) and pain (78%) For patients with T1DM, 71% had a PCP appointment made but only 33% attended the appointment. Patients with T1DM attended endocrinology appointments less than half the time (38%). For patients with IBD, 64% were scheduled a PCP appointment, and 67% attended. Adherence rate to GI appointments was 84%. For patients with SLE, 77% had a PCP appointment scheduled, and 30% attended. The majority of patients (61%) had rheumatology appointments scheduled, and 46% attended.
Conclusions: Young adults with CCOD were more likely to attend their specialist appointment than with their PCP. Despite high frequency of scheduled appointments, adherence rates are low among this group. Hospitalists must look at other interventions rather than just scheduling the appointment in order to improve adherence, such as evaluating for potential social barriers and partnering with outpatient clinics to determine other opportunities, such as telemedicine. Future research should be done to determine effective interventions to improve appointment adherence in order to decrease readmissions, particularly among high-utilizing populations.