245 Association of Missed Outpatient Appointments and Emergency Department Visits and Inpatient Admissions

Abstract

Health care cost controls have focused on improving primary care access to avoid preventable and costly emergency department (ED) and inpatient (IP) admissions. Research on missed outpatient appointments has focused on ED and hospital admission follow-up rather than focusing on missed appointments as potentially leading to or being associated with ED and hospital admissions. One objective of this study is to describe the association of missed outpatient appointments with ED and IP stays while adjusting for demographic, payer type, and health status. A second objective is to establish if a correlation exists between the number of missed appointments and the number of ED visits or IP stays. A third objective is to describe the relationship between the timing of missed appointments relative to ED visits or IP stays. Retrospective cross-sectional data from individuals who had any appointment within the HealthPartners care system was extracted from insurance claims data and the electronic medical record for the calendar years 2011 to 2012. Patients who had at least one outpatient clinic appointment were included. The number of ED visits, number of IP stays, age, sex, payer type, adjusted clinical group (ACG) score, and timing of the missed outpatient visit relative to the ED visit and IP stay were collected. Results were adjusted for age, sex, payer type, and ACG score using logistic regression. Chi-square tests and Spearman correlations were used to assess the associations between the number of missed outpatient appointments and ED visits and IP stays. A 14-day period before and after ED or IP stay was used as time frame to evaluate proximity of missed appointment to ED or IP stay. A total of 307,755 patients were included in this analysis. Patients who miss appointments are more than twice as likely to have an ED visit (OR 2.635, 95% CI 2.584-2.687) and IP stay (OR 2.055, 95% CI 2.001-2.111). After adjusting for age, sex, payer type, and ACG score, the patients who miss appointments do not have increased odds of IP stay (OR 0.976, 95% CI 0.943-1.010) but still have increased odds of visiting the ED (OR 1.593, 95% CI 1.558-1.629). There is a weak positive association between the number of missed appointments and ED visits (P=.199, 95% CI 0.195-0.202) and IP stays (P=.108, 95% CI 0.104-0.111). Missed outpatient appointments tend to occur more often in the 14 days prior to an ED visit or IP stay (10.15%, 95% CI 9.93-10.38) than after an ED visit or IP stay (6.51%, 95% CI 6.33-6.69). Patients who miss outpatient appointments are more likely to visit the ED than those patients who do not miss outpatient appointments but are not more likely to have an IP stay. There is a weak but positive correlation between the number of missed appointments and ED visits and IP stays. Missed appointments are more likely to precede an ED visit or IP stay than follow and ED visit or IP stay. Decreasing the number of missed appointments and improving follow-up for patients who miss appointments may decrease ED utilization.