Identifying Patient Factors Associated with Subspecialty Appointment Attendance Rates After Neonatal Intensive Care Unit Discharge

Our objective was to understand the rates of missed follow-up appointments following discharge from a tertiary neonatal intensive care unit (NICU) over the course of 1 year. We abstracted demographic and clinical information from the medical record into a database, including appointment referrals and outcomes of those appointments. Follow-up compliance data were reviewed for one calendar year following NICU discharge for each patient. Using our definition of “lost-to-follow-up” (LTFU), of 154 neonates reviewed, 111 (72.1%) were not LTFU, while 43 (27.9%) were LTFU for at least one sub-specialty. Adjusted for co-variates, children who were LTFU had more follow-up appointments (odds ratio [OR]: 1.53 for one appointment increase, 95% confidence interval [CI]: [1.20, 1.99]), were more likely to be discharged with a medical device (OR: 1.00, 95% CI: [0.36, 2.77]) and were more likely to have Medicaid or no health insurance at admission (OR: 3.45, 95% CI: [1.43, 9.19]). Our study suggests that financial stability in relation to insurance type may warrant further attention for missing medically necessary follow-up services. Additionally, increased number of follow-up appointments recommended or scheduled at the time of NICU discharge puts those infants at higher risk for becoming LTFU. Overall, maximizing the use of multidisciplinary follow-up clinics to reduce the total number of clinic appointments required may increase NICU follow-up attendance.