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Michelle Abou-Jaoude, Jessica Crawford, Richard Kryscio, Daniel B Moore; Accuracy of ophthalmology clinic follow up in the incarcerated patient population. Invest. Ophthalmol. Vis. Sci. 2018;59(9):5231.
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Incarcerated patients represent a uniquely vulnerable population in the outpatient ophthalmology setting, but the reliability of follow-up in this population is unclear. We performed a retrospective, observational chart review to evaluate the accuracy and timeliness of follow up in the incarcerated patient population and to determine whether any factors are associated with loss to follow up.
Retrospective observational chart review of patients at one academic center identified via billing data as having at least one encounter billed to a correctional facility between July of 2012 and September 2016. 511 charts were identified, 24 charts were not found so 487 charts were abstracted for a total of 2013 encounters. For each encounter, data was recorded on patient age, gender, incarcerated status at the time of encounter (a subset of patients had encounters before or after incarceration), evaluating subspecialty/attending, diagnosis, paper vs electronic record, operative status, interventions performed, follow up interval requested, acuity, and actual time to subsequent follow up. Outcomes measured included no-show rate as well as timeliness, which was defined as follow up within 1.5x the requested period. Comparative analysis was performed using SAS and SPSS computational software.
Of the 487 charts, 111 patients were seen once with no specific follow up interval requested. But of the 376 charts with more than one encounter, 241 had specific follow up requested when they ultimately no-showed (65%). Factors found to have significant associations with subsequent loss to follow up include whether a procedure was performed (p<0.0001), acuity level (p<0.0001), incarcerated status (p=0.0408). Factors with no significant association with no-show rate included age (p=0.6128), subspecialty (0.2423), type of medical record (p=0.9521), gender (p=0.4358), and overall postoperative status (P=0.5374).
Significant gaps in continuity of care exist in the incarcerated patient population. Factors associated with loss to follow up included acuity level, incarcerated status, and not having an intervention performed. Further study is needed to understand how these gaps compare to those in the general population, and to identify ways to improve these outcomes.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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