“Patient Lost to Follow-up”: Opportunities and Challenges in Delivering Primary Care in Academic Medical Centers

Background Academic health centers (AHCs) face unique challenges in providing continuity to a medically and socially complex patient population. Little is known about what drives patient loss in these settings. Objective Determine physician- and patient-based factors associated with patient loss in AHCs. Design Retrospective cohort study, embedded qualitative analysis. Setting Academic health center. Participants All visits from 7/1/2014 to 6/30/2019; 89 physicians (51%) participated in a qualitative analysis. Measures Physician-based factors (gender, years of service, hours of practice per week, trainee status, and departure during the study period) and patient-based factors (age, gender, race, limited English proficiency, public health insurance, chronic illness burden, and severe psychiatric illness burden) and their association with patient loss to follow-up, defined as a lapse in provider visit greater than 3 years. Results We identified 402,415 visits for 41,876 distinct patients. A total of 9332 (22.3%) patients were lost to follow-up. Patient factors associated with loss to follow-up included patient age