Intensive Intervention Improves Primary Care Follow-up for Uninsured Emergency Department Patients

Horwitz, Sarah M.; Busch, Susan H.; Balestracci, Kathleen M.B.; Ellingson, Katherine; Rawlings, James

doi:10.1197/j.aem.2005.02.015

Cited by 42 publications

(76 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Improved access to primary care via an enhanced ED referral system has been demonstrated. 3,4 However, this has been associated with mixed results on subsequent ED utilization, with one recent study showing that it increased primary care utilization while decreasing ED use, 5 while another found no significant reduction in ED utilization. 2 We performed a retrospective observational study to test the hypothesis that a more timely referral to a primary care provider will increase the rate of successful initial follow-up and that this in turn will lead to higher rates of an ongoing relationship between the referred patient and the FQHC and result in lower rates of subsequent ED utilization.…”

mentioning

confidence: 99%

Follow‐up to a Federally Qualified Health Center and Subsequent Emergency Department Utilization

Scherer

Lewis

2010

Academic Emergency Medicine

View full text Add to dashboard Cite

Objectives: Determine if 1) proximity of referral to a federally qualified health center (FQHC) improves initial follow-up rates for discharged emergency patients, 2) improved initial follow-up rates are associated with improved rates for an ''ongoing relationship'' with the FQHC, and 3) an ongoing relationship with an FQHC is associated with decreased subsequent emergency department (ED) utilization over a 2-year follow-up period.Methods: An expedited referral system was initiated just prior to January 2004 for discharged ED patients referred to an FQHC. Referral categories were as follows: R1 = next-day; R2 = 2 to 7 days; R3 = 2 to 3 weeks; and R4 = follow-up as needed. The FQHC database for 2004-2006 was merged with the ED database from 2004 through 2006. The FQHC database contained all ED referrals, the referral category, whether the patient kept his or her initial ED referral appointment, all subsequent scheduled clinic appointments, and whether the patient kept any of the subsequent scheduled appointments. We compared initial referral follow-up rates and subsequent scheduled visits to the FQHC for each referral category, over a 2-year follow-up period. We evaluated the effects of age, sex, marital status, insurance status, initial triage score, race, comorbidities, and number of prescription medications on initial follow-up, and subsequent kept appointments with the FQHC. We defined an ''ongoing relationship'' as one or more kept scheduled appointments annually. Finally, we compared the number of subsequent ED visits over the follow-up period between patients who maintained an ongoing relationship with the FQHC and those who did not, before and after correcting for the demographic and clinical factors.Results: There were 520 referrals over the study period. Follow-up rates ranged from 37.5% (95% confidence interval [CI] = 13.5% to 69.6%) for R1 to 9.0% (95% CI = 4.4% to 17.0%) for R4. The overall ongoing relationship rate was 7.1% (95% CI = 5.2% to 9.7%) and had weak association with temporal proximity of referral. On bivariate analysis, older age, female sex, white race, one or more comorbidities, and three or more medications were associated with increased rates of initial follow-up. These factors (with the exception of race) were also associated with increased rates of developing an ongoing relationship. Patients with an ongoing relationship with the FQHC had more repeat ED visits over the study period than did patients without (3.6 vs. 1.7, p = 0.003). However, this difference was no longer evident after adjusting for age, race, comorbidities, and medication usage.Conclusions: Overall patient follow-up to an FQHC was low, but increased with next-day or same-week referral. The ongoing relationship rate was low, but increased with temporal proximity of ED referral. Increased comorbidities and medication usage were significantly associated with increased initial followup rates, development of an ongoing relationship, and subsequent ED utilization. Patients with an ongoing relationship with the FQH...

show abstract

mentioning

confidence: 99%

Follow‐up to a Federally Qualified Health Center and Subsequent Emergency Department Utilization

Scherer

Lewis

2010

Academic Emergency Medicine

View full text Add to dashboard Cite

show abstract

“…Moreover, the percentage of patients without insurance who are evaluated by a PCP has dropped dramatically, decreasing 37% between 1996 and 2001. [8][9][10] Many individuals without access to primary care have risk factors for diabetes and present to the ED seeking care for unrelated complaints and illnesses. The ED provides medical care to a unique population that has limited access to screening and preventive interventions and, thus, wider adoption of screening initiatives in the ED may improve the health of this vulnerable population.…”

mentioning

confidence: 99%

Detection of Undiagnosed Diabetes and Prediabetic States in High‐risk Emergency Department Patients

Charfen

Ipp

Kaji

et al. 2009

Academic Emergency Medicine

View full text Add to dashboard Cite

show abstract

“…Several factors contribute to crowding, including a lack of efficient patient movement through the process of care [13], extensive use of ED services by frequent users [8,9,14], and reliance on the ED for nonurgent or ambulatory care sensitive conditions that could be treated in primary care settings [15][16][17]. Because such lack of timely and effective access to primary care is a key factor in ED usage [16,[18][19][20][21][22], numerous policymakers have called for stronger linkage between community-based health care providers and EDs [6,15].…”

Section: Introductionmentioning

confidence: 99%

“…In a recent review of ED care coordination literature, 4 out of 7 randomized studies focused on developing a post-ED treatment plan and obtaining appropriate post-ED care were effective in improving follow-up care and reducing repeat ED visits [11][12][13][14][15]. To date care coordination programs have often used intensive case management or relied upon specialized, highly-paid, clinical staff, such as social workers, nurses and physicians [21][22][23][24].…”

Section: Introductionmentioning

confidence: 99%

Urban Patient Navigator Program Associated with Decreased Emergency Department Use, and Increased Primary Care Use, among Vulnerable Patients

Garbers¹,

Peretz²,

Greca³

et al. 2016

J Community Med Health Educ

View full text Add to dashboard Cite

Background: Receiving non-emergent care in the Emergency Department (ED) setting may disrupt continuity of care, may lead to less effective preventive care, and often contributes to overcrowding. Community Health Worker (CHW)-driven patient navigator programs that connect patients to primary care are a promising approach to enhance quality of care for patients and to reduce preventable ED utilization.

show abstract

Intensive Intervention Improves Primary Care Follow-up for Uninsured Emergency Department Patients

Abstract: This project has demonstrated that it is possible to improve primary care follow-up for uninsured ED patients.

Cited by 42 publications

References 12 publications

Follow‐up to a Federally Qualified Health Center and Subsequent Emergency Department Utilization

Follow‐up to a Federally Qualified Health Center and Subsequent Emergency Department Utilization

Detection of Undiagnosed Diabetes and Prediabetic States in High‐risk Emergency Department Patients

Urban Patient Navigator Program Associated with Decreased Emergency Department Use, and Increased Primary Care Use, among Vulnerable Patients

Contact Info

Product

Resources

About