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.
Wheeler
Kate
K
Department of Medicine, Emory University School of Medicine, and the Grady Health System, Atlanta, GA, USA.
Crawford
Rochanda
R
McAdams
Debra
D
Benel
Sonia
S
Dunbar
Virginia G
VG
Caudle
Jane M
JM
George
Christopher
C
El-Kebbi
Imad
I
Gallina
Daniel L
DL
Ziemer
David C
DC
Cook
Curtiss B
CB
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