Abstract
Purpose :
Being lost to follow-up (LTF) places patients at risk for vision loss from delays in diagnosis and treatment of eye disease. This study aimed to identify clinical and demographic factors associated with LTF among patients with advanced age-related macular degeneration (AMD) and sought to return them to care.
Methods :
A custom reporting tool was used to identify established patients with advanced AMD who had not returned for eye care between October 31, 2021 and November 1, 2022. Stage of AMD was determined for each patient based upon billed ICD-10-CM codes. A manual chart review was performed to exclude patients who were documented to not require further eye care. Those patients identified as LTF were engaged by means of a targeted telephone outreach aimed at returning them to care. Linear regression was used to identify variables associated with becoming LTF as well as accepting return for subsequent eye care.
Results :
Out of 1269 established patients with AMD, 105 failed to return for recommended eye care (8.3%). LTF patients tended to be older (89.2±8.9 years vs. 87.2±8.5 years, p=0.022), more commonly diagnosed with advanced dry AMD (11.5% versus 7.4%, p = 0.032), live farther from the eye clinic (32±53 miles vs. 13±22 miles, p<0.001), and have worse vision in their better-seeing eye (0.683 logMAR vs. 0.566 logMAR, p=0.025) and worse-seeing eye (1.388 logMAR vs. 1.235 logMAR, p=0.043). Telephone-based outreach successfully contacted 62 patients (59%), 43 through a family member or healthcare proxy. Voicemails with instructions for how to contact the clinic were left for 31 patients (30%). Twelve patients were unreachable (18%), seven of whom did not have working phone numbers on file. Of those contacted, 20 patients expressed a willingness to return for future care (five of whom immediately proceeded to schedule return appointments and four after receiving voicemails), 25 patients reported that they had since transferred or otherwise declined further care, and 21 patients had died since their last appointment. Most calls took on average less than five minutes to complete (2.8±1.9 minutes). Patients willing to return for care spent longer on the phone (OR: 1.844, 95% CI: 1.301-2.613, p<0.001).
Conclusions :
There is a substantial risk that older patients with advanced AMD become LTF. Direct outreach can provide a pathway for vulnerable patients to return to care.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.