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Ann Emerg Med. 2018 Apr;71(4):487-496.e1. doi: 10.1016/j.annemergmed.2017.08.045. Epub 2017 Oct 9.

Insurance Status and Access to Urgent Primary Care Follow-up After an Emergency Department Visit in 2016.

Author information

1
Department of Emergency Medicine, Yale School of Medicine, New Haven, CT. Electronic address: shih-chuan.chou@yale.edu.
2
Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, CT.
3
Transitions Clinic, Yale-New Haven Hospital, New Haven, CT.
4
Department of Emergency Medicine, Yale School of Medicine, New Haven, CT.
5
Department of Emergency Medicine, Yale School of Medicine, New Haven, CT; Robert Wood Johnson Clinical Scholars Program, Yale School of Medicine, New Haven, CT; Department of Health Policy, Yale School of Public Health, New Haven, CT.
6
Department of Emergency Medicine, Yale School of Medicine, New Haven, CT; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT.

Abstract

STUDY OBJECTIVE:

We examine the availability of follow-up appointments for emergency department (ED) patients without established primary care by insurance and clinical condition.

METHODS:

We used "secret shopper" methodology, employing 2 black men to telephone all 53 primary care practices in greater New Haven, posing as new patients discharged from the ED and requesting follow-up appointments. Each practice received 6 scripted calls from each caller during an 8-month period, reflecting all possible scenarios based on 3 insurance types (Medicaid, state exchange, and commercial) and 2 conditions (hypertension and back pain). Primary outcome was the proportion of calls that obtained an appointment in 7 calendar days (7-day appointment rate). Secondary outcomes included overall appointment rate and appointment wait time.

RESULTS:

Among the total of 604 calls completed, the 7-day appointment rate was 30.7% (95% confidence interval [CI] 22.6% to 38.8%). Compared with commercial insurance, Medicaid calls had lower 7-day rate (25.5% versus 35.7%; difference 10.2%; 95% CI 2.2% to 18.1%) and overall appointment rate (53.5% versus 77.8%; difference 24.4%; 95% CI 13.4% to 35.4%). There was no significant difference between state exchange and commercial insurance calls in 7-day rate (30.9% versus 35.7%; difference 4.8%; 95% CI -3.1% to 12.6%) or overall appointment rate (73.4% versus 77.8%; difference 4.4%; 95% CI -2.7% to 11.6%). Back pain, compared with hypertension, had lower 7-day appointment rate (27.6% versus 33.7%; difference 6.1%; 95% CI 1.0% to 11.2%), but no significant difference in overall appointment rates (67.0% versus 69.4%; difference 2.4%; 95% CI -2.7% to 7.5%).

CONCLUSION:

For patients without established primary care, obtaining timely follow-up after acute care in the ED is difficult, particularly for Medicaid beneficiaries.

[Indexed for MEDLINE]

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