Association between non-attendance to outpatient clinics and emergency department consultations, hospitalizations and mortality in a Health Maintenance Organization

GIUNTA, DIEGO HERNÁN; ALONSO SERENA, MARINA; LUNA, DANIEL; PERONI, MARIA LETICIA; SANCHEZ THOMAS, DIEGO; BINDER, FERNANDO; BLUGERMAN, GABRIELA ALEJANDRA; FUENTES, NORA; ELIZONDO, CRISTINA MARIA; GONZALEZ BERNALDO DE QUIRÓS, FERNAN

International Journal of Health Planning and Management

John Wiley and Sons Ltd

Año: 2020 vol. 35 p. 1140 - 1156

0749-6753

Background: Non-attendance to scheduled medical appointments in outpatient clinics is a problem that affects patient health and health-care systems. Objective: Evaluate association of non-attendance to scheduled appointments in outpatient clinics and Emergency Department (ED) visits, hospitalizations and mortality. Methods: Retrospective cohort study of outpatients enrolled in 2015 to 2016 in the Hospital Italiano de Buenos Aires HMO with over five scheduled appointments. Individual non-attendance proportion was obtained by dividing missed over scheduled appointment numbers in the 365 days prior to index date. Outcomes were evaluated with a Cox proportional-hazards or Fine and Gray model for competing risks. We adjusted by several variables. Results: Sixty-five thousand two hundred sixty-five adults were included. Mean age was 63.6 years (SD 18.16), 29.9% male. Outpatients had average 10.18 (SD 5.59) appointments. Non-attendance the year before the index appointment had a median of 20%. A 10% increase in non-attendance was significantly associated with ED visits (asHR 1.19; 95%CI 1.08-1.32, P