I'm a research assistant in a large orthopedic clinic. We are having some trouble tracking with patients long-term. They come back for their early follow-up appointments, but then fizzle out later. We'd like to do some studies over five year increments (5, 10, 15). How are other clinics doing this?

These days more and more doctors are keeping long-term records. It helps give them an idea of what works well and what doesn't. For example problems with joint replacements can develop years later that could have been stopped early with regular follow-up exams.

Patient education is the first key. Patients must be told about the importance of keeping their follow-up appointments. Sometimes patients get "lost" because they move or die. They should be reminded to let the doctor's office staff know if there's any change in their address or phone number. Family members can be asked to notify the doctor's office in case of a major change in health, location, or even in the case of death.

The internet is also a useful tool. Various free search engines can be used to find patients who are lost in follow-up. The Social Security Death Index (http://www.ancestry.com) can be used to find patients who have died. Telephone directories such as http://www.anywho.com or http://www.superpages.com are also available.