Inpatient to outpatient transfer of care in urban patients with diabetes: patterns and determinants of immediate postdischarge follow-up.
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.
Department of Medicine, Emory University School of Medicine, and the Grady Health System, Atlanta, GA, USA.
Kate
K
Wheeler
Rochanda
R
Crawford
Debra
D
McAdams
Sonia
S
Benel
Virginia G
VG
Dunbar
Jane M
JM
Caudle
Christopher
C
George
Imad
I
El-Kebbi
Daniel L
DL
Gallina
David C
DC
Ziemer
Curtiss B
CB
Cook
D000328:Adult; D000359:Aftercare / Q000706:statistics & numerical data*; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D003266:Continuity of Patient Care / Q000706:statistics & numerical data*; D003920:Diabetes Mellitus / Q000628:therapy*; D005260:Female; D005845:Georgia; D006773:Hospitals, Municipal; D006801:Humans; D016015:Logistic Models; D008297:Male; D017057:Medically Uninsured; D008875:Middle Aged; D010044:Outpatient Clinics, Hospital / Q000706:statistics & numerical data; D010349:Patient Compliance; D012189:Retrospective Studies; D014505:Urban Population / Q000706:statistics & numerical data; D014600:Utilization Review