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Patterns and Determinants of Immediate Postdischarge Follow-up

Kate Wheeler, MD; Rochanda Crawford, BSN; Debra McAdams, BSN; Sonia Benel, BSN; Virginia G. Dunbar, BS; Jane M. Caudle, MLn; Christopher George, MS; Imad El-Kebbi, MD; Daniel L. Gallina, MD; David C. Ziemer, MD; Curtiss B. Cook, MD

Arch Intern Med. 2004;164:447-453.

Background  A key opportunity for continuing diabetes care is to assure outpatient follow-up after hospitalization. To delineate patterns and factors associated with having an ambulatory care visit, we examined immediate postdischarge follow-up among a cohort of urban, hospitalized patients with diabetes mellitus.

Methods  Retrospective study of 658 inpatients of a municipal hospital. Primary data sources were inpatient surveys and electronic records.

Results  Patients were stratified into outpatient follow-up (69%), acute care follow-up (15%), and those with no follow-up (16%); differences between groups were detected for age (P = .02), percentage discharged with insulin (P = .03), and percentage receiving a full discount for care (P<.001). Among patients with a postdischarge visit, 43% were seen in our specialty diabetes clinic, and 26% in a primary care site. Adjusted analyses showed any follow-up visit significantly decreased with having to pay for care. The odds of coming to the Diabetes Clinic increased if patients were discharged with insulin, had new-onset diabetes, or had a direct referral.

Conclusions  In this patient cohort, most individuals accomplished a postdischarge visit, but a substantial percentage had an acute care visit or no documented follow-up. New efforts need to be devised to track patients after discharge to assure care is achieved, especially in this patient population particularly vulnerable to diabetes.

From the Department of Medicine, Emory University School of Medicine, and the Grady Health System, Atlanta, Ga. Dr Cook is now with the Mayo Clinic, Scottsdale, Ariz. The authors have no relevant financial interest in this article.

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