Correlates of keeping post-discharge appointments at a transitional care center: Implications for medical care disparities

Abstract

Objective: Over the past decade, transitional care (TC) programs have demonstrated initial benefits for decreased care costs, reduced rehospitalizations and emergency department visits via care coordination team activities. Patients who completed their TC follow-up appointment subsequently have less frequent ER visits. The current study addressed correlates of missed appointments in a sample of under-investigated, mostly vulnerable (e.g., middle-aged, uninsured) patients. Methods: We conducted a retrospective observational study of an appointment database for patients enrolled at a major transition center during the first three years since its establishment in Northern Florida. Patients (n = 2,146) were referred to a Transitional Care Center (TCC) from a regional medical center after discharge. The type of insurance and demographic characteristics of the patients was used to predict missed appointments. Results: Logistic regression analyses indicated that privately insured patients were more likely and Black publicly and privately insured patients were less likely to keep first appointments. No effect on keeping appointments was seen for uninsured patients. Conclusions: Our findings suggest that an appointment referral is a necessary but not sufficient step for the accomplishment of TC goals. Medical teams need to collaborate with other health professionals, such as social workers, to identify the barriers to keeping appointments and ensure effective solutions for achieving the goal of preventing future ER visits and rehospitalization.