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Overview

Followup is the act of making contact with patients or their caregivers at a later, specified date to check on patients’ progress since their last appointment. Appropriate followup can help you to identify misunderstandings and answer questions, as well as make further assessments and adjust treatments. In addition, followup helps to promote a trusting relationship between you and your patients.

Action

Decide on the reasons for followup and who will be responsible for followup.

Who follows up depends on the purpose of the communication.

Choose the ways your office will follow up.

• Ask patients how they would like to be contacted. Just because they have a mobile phone does not mean they want to be texted. Do not rely solely on electronic communication. Patients may not check their devices regularly. 
• Phone. Talking on the phone allows patients to ask questions and callers to reinforce important points and check understanding. (Go to Communicate Clearly: Tool #4 and Use the Teach-Back Method: Tool #5.)
• Secure email. Secure email is part of many patient portals and can be an effective way to communicate with some patients. Make sure your emails are easy to understand (e.g., do not use medical terminology). Be sure to tell patients when and how often you check your email. Sensitive health and personal information should not be sent through unsecured email.
• Texting. For patients who use text messaging, this approach can be effective for sending patient reminders and answering quick questions. Be sure that patients are willing to be contacted in this manner, as they may be charged for receiving texts from your office.
• Postal mail. Postal mail can be used to share information, such as normal lab results and appointment reminders. This Lab Results Letter provides an example of an easy-to-understand letter explaining the need for followup.

Initiate and track followup.

• Identify the types of patients who would benefit from followup, such as patients:
  • On high-risk medicines. 
  • With action plans to self-manage chronic conditions.
  • With missed appointments.
  • Recently discharged from the hospital.
• Decide who will be responsible for each step in the process for each type of followup.
• Identify an appropriate schedule for followup.
• Establish systems for tracking followup through the electronic health record (EHR) or by using a computer-based calendar.
• Identify the staff members who will update these tracking systems.

Incorporate followup into home monitoring programs.

• Ask your patients which system for tracking key clinical values (e.g., blood sugar, blood pressure, weight, pain) between visits they are most comfortable using. Reporting can be done with:
  • Simple forms.
  • Patient portals.
  • Automated calling systems.
  • Apps such as the ´óÏóÊÓƵChallenge winner . 
  • Devices that automatically communicate results to the practice. 
• Train patients to take and report measures. Make use of resources such as these from Million Hearts^® on . 
• Develop a system to review patient-reported outcomes and identify values that need followup.
  • If patients are using paper forms, instruct them to contact the practice when their clinical values are of concern (e.g., blood pressure above 140/90, weight gain of more than 2 to 3 pounds in a day for heart failure patients).
• Follow up with patients, thanking them for recording the information, highlighting how helpful it is, and providing clinical feedback, such as
  • "It looks like you are doing a good job of keeping your blood sugar under control."
  • "Your cholesterol is higher than we'd like it to be. Let's talk about what you are eating and whether we should adjust your medicine."

Track Your Progress

Select the records of a sample of patients who should have received followup after a recent visit (e.g., patients with heart failure).

• Count the number of patients who received followup actions that were scheduled in your tracking system. 
• Count the number of followup actions (e.g., phone calls, emails, letters, automated calls) that were performed within the desired time frame. 
• Note what was achieved by the followup contacts (e.g., medicine changes, referrals made, clarification of medicine regimens).
• Before implementing this tool and 2, 6, and 12 months later, collect patient feedback on a selection of questions about this tool from the Health Literacy Patient Feedback Questions. 
• Refer to Tool 2: Assess Organizational Health Literacy and Create an Improvement Plan to learn how to use data in the improvement process