Missed Appointments: Are They a Sign of Deeper Medical Care Disparities?
"New research sheds light on why some patients are more likely to miss critical follow-up care, hindering efforts to improve health outcomes and reduce hospital readmissions."
Ensuring continuous care across different healthcare settings is vital for maintaining high-quality patient outcomes. Transitional care (TC) programs, designed as time-limited, interdisciplinary services, play a crucial role in facilitating the smooth transfer of patients between care levels, aiming to prevent adverse outcomes among at-risk populations.
These TC services are specifically targeted at reducing preventable rehospitalizations (RH) and emergency room (ER) over-utilization, ultimately leading to lower healthcare costs. Over the past decade, a growing body of evidence has demonstrated that TC programs, encompassing coordinated care activities, can effectively decrease healthcare expenses, lower rehospitalization rates and ER visits, and improve patient satisfaction.
A recent study highlighted the impact of completing TC follow-up appointments, revealing that patients who attended these appointments experienced fewer ER visits in the year following their discharge, reinforcing the importance of adherence to TC programs. Despite the proven benefits and ongoing innovations in TC, significant gaps persist, particularly concerning patient adherence to initial follow-up appointments after hospitalization.
Unpacking the Reasons Behind Missed Appointments
Published in the Journal of Hospital Administration in March 6, 2017, a study by Henry Carretta, Seyfullah Tingir, Cara Pappas, and Amy L. Ai, titled “Correlates of keeping post-discharge appointments at a transitional care center: Implications for medical care disparities” investigates the topic of patients that missed appointments. The study addresses the implementation of transitional care (TC) for one of the most vulnerable populations (e.g., middle-aged chronic disease patients with limited health care access). The first round of penalties from the Readmission Reduction Program within the Affordable Care Act showed that hospitals caring for the sickest, poorest, and most vulnerable patients often have exceptionally high RH rates and were more likely to incur such penalties.
- Privately insured patients were more likely to keep their initial appointments.
- Black patients with public or private insurance were less likely to attend their first appointments.
- No significant effect was observed for uninsured patients.
- The study underscores that merely referring patients to appointments is insufficient; healthcare teams must proactively address barriers to attendance.
Moving Forward: Bridging the Gap in Transitional Care
The study underscores the critical need for a multi-faceted approach to transitional care, one that goes beyond simply scheduling appointments. By proactively addressing social determinants of health and collaborating with various healthcare professionals, we can work towards ensuring equitable access to care and improving health outcomes for all patients. It provides information from a large and complete sample of the first three years of a TC primarily serving an under-investigated population. Linking hospital data to TC appointment data is likely important for understanding the TC population.