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Open Access Research article

No-shows to primary care appointments: subsequent acute care utilization among diabetic patients

Lynn A Nuti1, Mark Lawley2, Ayten Turkcan3, Zhiyi Tian4, Lingsong Zhang45, Karen Chang1, Deanna R Willis6 and Laura P Sands7*

Author Affiliations

1 School of Nursing, College of Health and Human Sciences, Purdue University, 502 N. University Street, West Lafayette, IN, 47907-2069, USA

2 Weldon School of Biomedical Engineering, Purdue University, 206 S. Martin Jischke Drive, West Lafayette, IN, 47907-2032, USA

3 Department of Mechanical and Industrial Engineering, Northeastern University, 360 Huntington Avenue, Boston, MA, 02115, USA

4 Regenstrief Center for Healthcare Engineering, Purdue University, 203 Martin Jischke Drive, West Lafayette, IN, 47907, USA

5 Department of Statistics, Purdue University, 150 N. University Street, West Lafayette, IN, 47907, USA

6 Department of Family Medicine, Indiana University School of Medicine, 1110 W Michigan Street, Long Hall, Suite 200, Indianapolis, IN, 46202, USA

7 School of Nursing, College of Health and Human Sciences, Center for Aging and the Life Course, Purdue University, 502 N. University Street, West Lafayette, IN, 47907-2069, USA

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BMC Health Services Research 2012, 12:304  doi:10.1186/1472-6963-12-304

Published: 6 September 2012

Abstract

Background

Patients who no-show to primary care appointments interrupt clinicians’ efforts to provide continuity of care. Prior literature reveals no-shows among diabetic patients are common. The purpose of this study is to assess whether no-shows to primary care appointments are associated with increased risk of future emergency department (ED) visits or hospital admissions among diabetics.

Methods

A prospective cohort study was conducted using data from 8,787 adult diabetic patients attending outpatient clinics associated with a medical center in Indiana. The outcomes examined were hospital admissions or ED visits in the 6 months (182 days) following the patient’s last scheduled primary care appointment. The Andersen-Gill extension of the Cox proportional hazard model was used to assess risk separately for hospital admissions and ED visits. Adjustment was made for variables associated with no-show status and acute care utilization such as gender, age, race, insurance and co-morbid status. The interaction between utilization of the acute care service in the six months prior to the appointment and no-show was computed for each model.

Results

The six-month rate of hospital admissions following the last scheduled primary care appointment was 0.22 (s.d. = 0.83) for no-shows and 0.14 (s.d. = 0.63) for those who attended (p < 0.0001). No-show was associated with greater risk for hospitalization only among diabetics with a hospital admission in the prior six months. Among diabetic patients with a prior hospital admission, those who no-showed were at 60% greater risk for subsequent hospital admission (HR = 1.60, CI = 1.17–2.18) than those who attended their appointment. The six-month rate of ED visits following the last scheduled primary care appointment was 0.56 (s.d. = 1.48) for no-shows and 0.38 (s.d. = 1.05) for those who attended (p < 0.0001); after adjustment for covariates, no-show status was not significantly related to subsequent ED utilization.

Conclusions

No-show to a primary care appointment is associated with increased risk for hospital admission among diabetics recently hospitalized.

Keywords:
No-show; Diabetes; Emergency department visits; Hospital admissions; Outcomes