Recommended care adherence: improved by patient reminder letters but with potential attenuation by the healthcare process complexity.

摘要: Background American adults receive the recommended care just over half of time for all services. Many patient reminder strategies have attempted to increase adherence rates preventative and chronic disease management. However, there is a lack data available in relation symptom-specific services identifying any contributions from organisational structures these rates. Purpose To identify efficacy differences letter on various categories services, as well analyse relationship between novel quantification healthcare system’s process complexity with Design Retrospective cohort study analysing pilot collected an urban, academic provider utilising letters. ParticipantsAdults attending one medical centre’s outpatient practice 2008 2009. InterventionTwo letters sent chronologically if was not completed appropriate frame. Main measures Adherence each service at baseline, after first second letters, non-adherence despite intervention. Process flow calculated composite score combining elements fastest complete routine order, number different steps departments involved, sites patients visit. ResultsPatient increased letter. Preventative Chronic Disease Management recommendations demonstrated additional moderate increases Referrals Radiology Diagnostic Testing (acute, symptom specific) Labs (acute non-acute) minimal rate Comparison inverse rates, particularly non-acute orders. ConclusionsOne seemed be sufficient most care. The may important predictive factor adherence.