Abstract: SA-PO909
Continuous System Improvements to Reinstate Kidney Patients Lost to Follow-Up
Session Information
- CKD: Clinical, Outcomes, Trials - III
November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: CKD (Non-Dialysis)
- 2102 CKD (Non-Dialysis): Clinical, Outcomes, and Trials
Author
- Lo, Lowell J., University of California San Francisco, San Francisco, California, United States
Group or Team Name
- UCSF Nephrology and Hypertension Faculty Practice Team
Background
In chronic disease clinics, reducing the number of patients who are lost to recommended follow-up (LTFU) may improve outcomes. We designed a method to identify LTFU patients and trigger a procedure to schedule appointments. Using this system at our nephrology clinic, we reduced the number of LTFU patients from 24% to 3.8% in one year. MDs activated an electronic medical record (EMR) trigger indicating follow-up (FU) time frame for 77% of visits. We sought to explore reasons for incomplete MD EMR triggers use and persistent LTFU patients.
Methods
We generated a monthly LTFU report that identifies patients who did not return to clinic in the recommended FU time frame. Clinical staff called these patients and classified them into three groups: “scheduled” (appointment made successfully); “no need to return” (patients transitioned to dialysis, transferred to another nephrologist, declined appointment, or died); or “active” (i.e. actively trying to reconnect). We aimed to increase MD use of the EMR trigger by faculty meeting reminders and administrative assistant prompts. Lastly, we identified explanation categories for patients persisted on the “active” list.
Results
We had 5730 patient visits from 1/31/2018 to 3/31/2019. MDs successfully used the EMR trigger on 3598 (62.8%) of the visits. The most common barriers for using the EMR trigger were: rotating trainees not familiar with this system; MDs running behind on charting; and MDs short on time during clinic. We identified 460 (12.8% of total visits) LTFU patients among whom 252 (54.8%) were “scheduled,”114 (24.8%) were designated “no need to return,” and 94 (20.4%) as “actively trying to reconnect.” Among the 94 patients, reasons we were unable to reach patients included homelessness; inaccurate contact information; and having multiple stressors at home causing postponement of routine care.
Conclusion
Retention in care is associated with improved outcomes. Our team has identified a method by which patients LTFU were identified and reconnected. A future goal may be to make MD trigger activation mandatory via EMR validation point. For the difficult to reconnect patients who may be the most vulnerable, a team approach with case management may improve the chances of reconnection. Limitations of our study are that we lack outcome data on patients who were LTFU and the development and implementation of the system is time-intensive.