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Health Network: Lost to Follow-Up

Lost to Follow-up

Health Network Associates regularly provide case management that connects patients to needed and, at times, lifesaving care, that they otherwise would struggle to attain. Health Network Associates remove numerous barriers to care, finding and booking appointments for patients at health centers, helping them connect with services like sliding fee scales  so they can afford their treatments, forwarding medical records to their new clinicians so their care can be continuous, arranging for transportation to the clinic, and more. Yet, at each step in the process, Health Network Associates encounter issues that, at times, result in a patient who is lost to follow-up.

Earlier this year, Norma Gonzalez, Health Network Associate, received enrollment forms from a health center on the East Coast for a 30-year-old Mexican migrant worker, Gabriela,* who had an abnormal pap smear.  Gabriela’s clinician on the East Coast had explained to her what her abnormal pap smear could mean, and the importance of getting follow-up care like a colposcopy. The clinician then filled out the enrollment form, including the consent form.

Unfortunately for Gabriela, the forms were incomplete. The forms had just one phone number for Gabriela and did not have additional contact details or an “anchor contact”-- a relative or friend who is not migrating who can help get in touch with the patient should other contact attempts fail. The health center also failed to forward any medical records, which might have provided additional details on her whereabouts.

“I try to call, text, WhatsApp, and Google text,” when patients are not responsive, explained Gonzalez. WhatsApp, in particular, is a critical tool for making contact with patients. Some patients do not have a United States phone number; others do not have a data plan on their phone. WhatsApp circumvents some of those barriers. “That’s where I get most of my contacts,” she said. “Sometimes, since they have our information, we wait to get a message on WhatsApp. They might contact us with another number through WhatsApp,” different from what is on the enrollment form. For Gabriela, however, the platform did not help. She did not respond to numerous calls or text messages on multiple platforms. 

Gabriela’s case emphasizes the importance of complete enrollment forms, particularly the anchor contact. Without an anchor contact or any additional information like a labor camp name or an emergency contact, Gonzalez was unable to do more for Gabriela. Her last step is to send Gabriela a final text message indicating that because she cannot get in contact with her, she is going to send the case to close.

“Sometimes they call us back” when that closing message is sent, Gonzalez said, who hopes this will be the case this time. “We provide all our information and contact numbers. Even if we close the case, we can reopen it if they contact us.”

From January to August 2023, under 5% of cases were sent to close without an outcome. These cases may have lacked medical records, a signed consent form may have been missing, or the Health Network Associate did not receive sufficient response from the patient after multiple contact attempts. Health Network Associates pursue as many avenues of communication with the patient as possible, but even with culturally and linguistically attuned case management, technological advances, and the support of foundations and charities to remove barriers, some patients are still unable to continue their care. 

Learn more about Health Network, access enrollment training videos, read other case studies, and explore Health Network programs:


*Names and identifying details may be generalized or altered to protect patient identity.




Associate Director of Communications