Association between non-attendance to outpatient clinics and emergency department consultations, hospitalizations and mortality in a Health Maintenance Organization

Background: Non-attendance to scheduled medical appointments in outpatient clinics is a problem that affects patient health and health-care systems.

Objective: Evaluate association of non-attendance to scheduled appointments in outpatient clinics and Emergency Department (ED) visits, hospitalizations and mortality.

Methods: Retrospective cohort study of outpatients enrolled in 2015 to 2016 in the Hospital Italiano de Buenos Aires HMO with over five scheduled appointments. Individual non-attendance proportion was obtained by dividing missed over scheduled appointment numbers in the 365 days prior to index date. Outcomes were evaluated with a Cox proportional-hazards or Fine and Gray model for competing risks. We adjusted by several variables.

Results: Sixty-five thousand two hundred sixty-five adults were included. Mean age was 63.6 years (SD 18.16), 29.9% male. Outpatients had average 10.18 (SD 5.59) appointments. Non-attendance the year before the index appointment had a median of 20%. A 10% increase in non-attendance was significantly associated with ED visits (asHR 1.19; 95%CI 1.08-1.32, P < .001) and all-cause mortality (aHR 7.57; 95%CI 4.88-11.73, P < .001). In the matched subcohort analysis we observed a crude significant association of non-attendance with ED visits (P < .001) and all-cause mortality (P < .001).

Discussion: Our findings show non-attendance could be a marker of health events that lead to emergency department evaluations and/or death.