Journal of General Internal Medicine

, Volume 2, Issue 4, pp 232–238 | Cite as

A controlled trial to increase office visits and reduce hospitalizations of diabetic patients

  • David M. Smith
  • Morris Weinberger
  • Barry P. Katz
Original Articles

Abstract

An intervention package was examined to determine its effectiveness in increasing office visits and in reducing the incidence of nonelective hospitalizations (those for urgent or emergent reasons). The intervention included mailings of information, appointment reminders, and intense follow-up by telephone of visit failures for rescheduling. Eight hundred fifty-four patients receiving drug therapy for diabetes mellitus were stratified by risk of nonelective hospitalization and randomly assigned to the control group or the intervention group. After two years, the intervention group averaged 9.1 per cent more kept scheduled visits per month than the control group (0.371 vs. 0.340, p=0.02). However, the mean incidence of nonelective hospitalizations per month was not significantly different between intervention and control groups (0.040 vs. 0.041, p=0.9), nor was there a difference in nonelective hospital days per month (0.443 vs. 0.425, p=0.7). The authors conclude that while mailings and telephone calls can increase office visits, the intervention is not sufficient to reduce morbidity necessitating nonelective hospitalizations of diabetic patients.

Key words

diabetes mellitus patient admissions ambulatory care hospitalization appointments and schedules 

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References

  1. 1.
    Miller LV, Goldstein J. More efficient care of diabetic patients in a county-hospital setting. N Engl J Med 1972;286:1388–91PubMedCrossRefGoogle Scholar
  2. 2.
    Runyan JW, Vander Zwaag R, Joyner B, Miller ST. The Memphis diabetes continuing care program. Diabetes Care 1980;3:382–6PubMedCrossRefGoogle Scholar
  3. 3.
    Schroeder SA. Lowering broken appointment rates at a medical clinic. Med Care 1973;11:75–8PubMedCrossRefGoogle Scholar
  4. 4.
    Gates SJ, Colborn DK. Lowering appointment failures in a neighborhood health center. Med Care 1976;14:263–7PubMedCrossRefGoogle Scholar
  5. 5.
    Shepard DS, Moseley TAE. Mailed versus telephoned appointment reminders to reduce broken appointments in a hospital outpatient department. Med Care 1976;14:268–73PubMedCrossRefGoogle Scholar
  6. 6.
    Bigby JA, Giblin J, Pappius EM, Goldman L. Appointment reminders to reduce no show rates. JAMA 1983;250:1742–5PubMedCrossRefGoogle Scholar
  7. 7.
    Smith DM, Norton JA, Roberts SD, Maxey WA, McDonald CJ. Unexpected hospital admissions among patients with diabetes mellitus. Arch Intern Med 1983;143:41–7PubMedCrossRefGoogle Scholar
  8. 8.
    Smith DM, Norton JA, Weinberger M, McDonald CJ, Katz BP. Increasing prescribed office visits. A controlled trial in patients with diabetes mellitus. Med Care 1986;24:189–99PubMedCrossRefGoogle Scholar
  9. 9.
    Smith DM, Weinberger M, Katz BP. Nonelective hospitalizations: predictable events in diabetes mellitus. J Gen Intern Med 1987;2:168–73PubMedCrossRefGoogle Scholar
  10. 10.
    McDonald CJ, Hui SL, Smith DM, et al. Reminders to physicians from an introspective computer medical record. A two-year randomized trial. Ann Intern Med 1984;100:130–8PubMedGoogle Scholar
  11. 11.
    Commission of Professional and Hospital Activities. The international classification of diseases, 9th revision. Clinical modification. Ann Arbor: Edwards Brothers, 1978Google Scholar
  12. 12.
    Grizzle JE, Starmer CF, Koch GG. Analysis of categorical data by linear model. Biometrics 1969;25:489PubMedCrossRefGoogle Scholar
  13. 13.
    Miller RG. Simultaneous statistical inference. New York: Springer-Verlag, 1981Google Scholar
  14. 14.
    National Center for Health Statistics. Haupt BJ. Utilization of short-study hospitals: annual summary for the United States, 1980. Series 13, No. 64. DHHS Pub. No. (PHS) 82-1725. Public Health Service. Washington, DC: U.S. Government Printing Office, March 1982Google Scholar
  15. 15.
    National Center for Health Statistics. Collins JG. Physician visits: volume and interval since last visit, United States, 1980. Series 10, No. 144, DHHS Pub. No. (PHS) 83-1572. Public Health Service. Washington, DC: U.S. Government Printing Office, June 1983Google Scholar
  16. 16.
    Sechrest L. Experiments and demonstrations in health services research. Med Care 1985;23:677–95PubMedCrossRefGoogle Scholar
  17. 17.
    Mazzuca SA, Moorman NH, Wheeler ML, et al. The diabetes education study: a controlled trial of the effects of diabetes patient education. Diabetes Care 1986;9:1–10PubMedCrossRefGoogle Scholar
  18. 18.
    Cohen SJ. Potential barriers to diabetes care. Diabetes Care 1983;6:499–500PubMedCrossRefGoogle Scholar

Copyright information

© Society of General Internal Medicine 1987

Authors and Affiliations

  • David M. Smith
    • 1
  • Morris Weinberger
    • 1
  • Barry P. Katz
    • 1
  1. 1.The Regenstrief Institute for Health CareIndiana University Medical CenterIndianapolis

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