Quality improvement and patient compliance with appointments

Does making newborn follow-up appointments from the hospital improve compliance?

OBJECTIVE

To test a system of arranging the first newborn follow-up appointments made from the hospital prior to discharge.

METHODS

Prospective randomized study of 328 term healthy newborns divided into control and intervention groups. As there were multiple practices, we checked for clustering in the two groups and then compared them for patient compliance with the first newborn appointment. We also compared the control and intervention groups for compliance with regard to insurance status.

RESULTS

There was difference between the control and intervention group in timeliness for the first appointment (control, 84.9%, intervention group, 94.2%, p=0.0062). There was also improvement in privately insured patients (control 89.1%, intervention 96.5%, p=0.0263), as well as in Medicaid+noninsured patients (control 64.7%, intervention 90.2%, p=0.0245).

DISCUSSION

We conclude that arranging for follow-up appointments from the hospital is a worthwhile inexpensive intervention that could significantly improve patient compliance with the first newborn visit.

Patient compliance with the first newborn visit appointment

OBJECTIVE

To analyze patient compliance regarding the first newborn visit after hospital discharge.

STUDY DESIGN

We selected at random 640 charts over a 1-year period from two community hospitals of healthy term newborns who were cared for by four practices in Kalamazoo, MI. We collected demographic data from the hospital chart and recorded the discharge order for time of posthospital follow-up. We then accessed the individual clinics' appointment logs to determine when the patient came for the first visit. Lateness was defined as appearance for appointment >24 hours after the time stated on the hospital discharge order. We studied patient lateness with respect to the clinic, maternal age, insurance status, and distance from the patient's home to the medical facility, using both univariate and multivariate analyses.

RESULTS

We demonstrated a significant difference in lateness of the first appointment between Medicaid and non-Medicaid patients in both the univariate (p<0.001) and multivariate (p=0.0003) analyses. We also demonstrated significant differences in the univariate analysis in patient lateness among the different practices (p<0.001) as well as lateness with regard to maternal age (p=0.0009). We did not attain significance in either analysis for patient lateness with regard to distance of home from the medical facility, or the hospital in which the baby was born.

CONCLUSION

We demonstrated a need to improve upon newborn follow-up from the hospital and suggest strategies for other communities to analyze the process and improve upon patient and practice compliance with that first appointment.