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American Journal of Medical Quality, Vol. 22, No. 6, 428-437 (2007)
DOI: 10.1177/1062860607305245

Factors Associated with Time to Follow-up of Severe Hyperkalemia in the Ambulatory Setting

Carlton Moore, MD

Division of General Internal Medicine, Department of Medicine, Mount Sinai School of Medicine, New York, New York, carlton.moore{at}mssm.edu

Jenny Lin, MD

Division of General Internal Medicine, Department of Medicine, Mount Sinai School of Medicine, New York, New York

Thomas McGinn, MD, MPH

Division of General Internal Medicine, Department of Medicine, Mount Sinai School of Medicine, New York, New York

Ethan Halm, MD, MPH

Division of General Internal Medicine, Department of Medicine and at the Department of Health Policy, Mount Sinai School of Medicine, New York, New York

Background. Few studies have investigated the time it takes physicians to follow up abnormal outpatient laboratory results. Methods. Medical record review of all adult patients seen at a primary care practice between January 2002 and December 2005 with serum potassium results ≥ 6.0 mEq/L. We used a proportional hazards model to assess factors associated with time to follow-up for episodes of hyperkalemia. Results. 259 of 48 333 serum potassium results met inclusion criteria. The median follow-up time was 3 days; after 30 days, 10% of cases had no follow-up. Residing in the same zip code as the clinic (HR = 1.39; P = .029), degree of hyperkalemia (HR = 2.97; P < .001), and renal insufficiency (HR = 1.41; P = .015) were associated with decreased time to repeat testing. Conversely, African Americans (HR = .51; P = .007) had increased time to repeat testing. Conclusions. Follow-up of abnormal laboratory results in outpatients is suboptimal and research is needed to better understand factors that delay follow-up. (Am J Med Qual 2007;22:428-437)

Key Words: follow-up • abnormal tests • medical errors • hyperkalemia • ambulatory


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