title: Compliance with post-hospitalization follow-up visits: rationing by inconvenience?
abstract: OBJECTIVE
  Appointment-keeping after hospitalization is a poorly understood link between inpatient and outpatient care. We investigated how health care system and patient characteristics influence appointment-keeping after discharge from an acute care hospitalization.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Urban public teaching hospital.
  
  
  METHODS
  All 372 consecutive eligible patients admitted over a 15 week period to medicine wards.
  
  
  METHODS
  We interviewed patients during hospitalization and after discharge, searched the hospital's electronic databases, and reviewed charts. We measured medication compliance, health care access and use, health status (SF-36), previous appointment compliance, and physician recommended follow-up appointments. Main outcome was appointment adherence after discharge.
  
  
  RESULTS
  Patients were primarily African American (71%), uninsured (64%), female (53%), and had a mean age of 48 years; 64% of first appointments after discharge were kept. Adjusted odds ratios (95% confidence intervals) for appointment-keeping were 3.3 (1.7, 6.5) for receiving a written appointment at discharge, and 0.50 (0.27, 0.90) for previous difficulty with obtaining health care. Readmission rates were not associated with appointment adherence.
  
  
  CONCLUSIONS
  Modifiable system, as well as patient, characteristics are associated with follow-up appointment-keeping. The practice of not giving patients written appointments at the time of discharge may constitute an implicit form of "rationing by inconvenience." Further studies should also evaluate potential associations between appointment-keeping and re-hospitalization.
authors.affiliation: University of Alabama at Birmingham, 35205-4785, USA. ckiefe@uab.edu
authors.forename: C I
authors.initials: CI
authors.lastname: Kiefe
authors.forename: G
authors.initials: G
authors.lastname: Heudebert
authors.forename: J B
authors.initials: JB
authors.lastname: Box
authors.forename: R M
authors.initials: RM
authors.lastname: Farmer
authors.forename: M
authors.initials: M
authors.lastname: Michael
authors.forename: C M
authors.initials: CM
authors.lastname: Clancy
mesh_terms: D000359:Aftercare / Q000706:statistics & numerical data*; D000407:Alabama; D001071:Appointments and Schedules; D003266:Continuity of Patient Care; D015276:Health Care Rationing; D006297:Health Services Accessibility; D006302:Health Services Research; D006745:Hospital Bed Capacity, 300 to 499; D006779:Hospitals, Public; D006801:Humans; D016015:Logistic Models; D010349:Patient Compliance; D010351:Patient Discharge; D011446:Prospective Studies; D017664:Uncompensated Care