Missed appointments in resident continuity clinic: patient characteristics and health care outcomes.
Missed appointments in resident continuity clinic: patient characteristics and health care outcomes.
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DOI：
10.4300/jgme-d-10-00199.1
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发表时间：
2011-09-01
影响因子：
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通讯作者：
Wieland, Mark L
中科院分区：
文献类型：
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作者：
Nguyen, Douglas L;Dejesus, Ramona S;Wieland, Mark L
背景：住院连续性诊所经常错过预约的患者是一个有充分证据的问题，但错过预约的比率是否与标准的学术实践不成比例，哪些患者因素导致了这些差异，以及经常错过预约的患者的医疗结果尚不清楚。方法：本研究的总体人群包括2006年1月至2008年12月期间在学术内科连续性诊所就诊5次或以上的患者。我们随机选择了325名住院医生看病的患者和325名由教职员工护理的患者。采用多元线性回归分析患者因素与错过预约之间的关系。使用Cox回归分析比较经常错过预约的患者和研究样本的其余患者之间的健康结果。结果：住院患者的错失率显著高于教职员工患者，但这种差异是由患者因素解释的。与错过更多预约相关的因素包括使用医疗翻译、医疗补助保险、更频繁的急诊科就诊、被困在诊所的时间更少以及与初级保健提供者进行办公室就诊的比例较低。经常错过预约的患者不太可能获得最新的预防保健服务，更有可能控制不好的血压和糖尿病。结论：我们发现，住院连续性诊所错过预约的不成比例频率是由患者因素和实践中断所解释的，而频繁错过预约的患者表现出更差的医疗保健结果。
BACKGROUND: Frequent missed patient appointments in resident continuity clinic is a well-documented problem, but whether rates of missed appointments are disproportionate to standard academic practice, what patient factors contribute to these differences, and health care outcomes of patients who frequently miss appointments are unclear.METHODS: The overall population for the study was composed of patients in an academic internal medicine continuity clinic with 5 or more office visits between January 2006 and December 2008. We randomly selected 325 patients seen by resident physicians and 325 patients cared for by faculty. Multivariate linear regression was used to examine the relationship between patient factors and missed appointments. Health outcomes were compared between patients with frequent missed appointments and the remainder of the study sample, using Cox regression analysis.RESULTS: Resident patients demonstrated significantly higher rates of missed appointments than faculty patients, but this difference was explained by patient factors. Factors associated with more missed appointments included use of a medical interpreter, Medicaid insurance, more frequent emergency department visits, less time impanelled in the practice, and lower proportion of office visits with the primary care provider. Patients with frequent missed appointments were less likely to be up to date with preventive health services and more likely to have poorly controlled blood pressure and diabetes.CONCLUSIONS: We found that the disproportionate frequency of missed appointments in resident continuity clinic is explained by patient factors and practice discontinuity, and that patients with frequent missed appointments demonstrated worse health care outcomes.