title: Recommended care adherence: improved by patient reminder letters but with potential attenuation by the healthcare process complexity.
abstract: BACKGROUND
  American adults receive the recommended care just over half of the time for all recommended services. Many patient reminder strategies have attempted to increase the adherence rates for preventative and chronic disease management. However, there is a lack of data  available in relation to adherence rates for symptom-specific recommended services and a lack of data identifying any contributions from the organisational structures to these adherence rates.
  
  
  OBJECTIVE
  To identify the efficacy and differences in patient reminder letter strategies  on various categories of recommended services, as well as to analyse the relationship between a novel quantification of a healthcare system's process complexity with adherence rates.
  
  
  METHODS
  Retrospective cohort study analysing pilot data collected from an urban, academic healthcare  provider utilising patient reminder letters.
  
  
  METHODS
  Adults attending one academic medical centre's outpatient practice from 2008 to 2009.
  
  
  METHODS
  Two reminder letters sent chronologically if the recommended care was not completed in the appropriate time frame.
  
  
  METHODS
  Adherence rates of each recommended service at baseline, after first and second reminder letters, and non-adherence rates despite the reminder letter intervention. Process flow complexity was calculated as a composite score combining elements of fastest time to complete  routine order, number of different steps in routine order, number of departments involved, and number of sites patients visit.
  
  
  RESULTS
  Patient adherence rates increased for all the recommended services after the first reminder letter. Preventative and Chronic Disease Management  recommendations demonstrated additional moderate increases after the second reminder letter. Referrals and Radiologogy and Diagnostic Testing (acute, symptom specific) and Labs (acute and nonacute) demonstrated additional minimal adherence rate increases after the second reminder letter. Comparison  of the process flow complexity demonstrated an inverse relationship between process complexity and adherence rates, particularly for non-acute orders.
  
  
  CONCLUSIONS
  One reminder letter seemed to be sufficient for most recommended care. The complexity of the healthcare process may  be an important predictive factor for patient adherence.
authors: Department of Family Medicine, Kaiser Permanente Woodland Hills Medical Center, Woodland Hills, CA 91367, USA. zzhan001@ucla.edu
authors: Zhou
authors: Z
authors: Zhang
authors: Jason
authors: J
authors: Fish
mesh_terms: D002908:Chronic Disease / Q000628:therapy; D015709:Correspondence as Topic; D003695:Delivery of Health Care; D006801:Humans; D008485:Medical Audit; D010349:Patient Compliance / Q000706:statistics & numerical data; D017010:Reminder Systems; D012189:Retrospective Studies; D014481:United States