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Am J Emerg Med. 2018 May;36(5):854-858. doi: 10.1016/j.ajem.2018.01.070. Epub 2018 Feb 4.

Patient centered medical homes did not improve access to timely follow-up after ED visit.

Author information

1
Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, United States. Electronic address: schou2@bwh.harvard.edu.
2
Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, United States. Electronic address: craig.rothenberg@yale.edu.
3
Robert Wood Johnson Clinical Scholars Program, Yale School of Medicine, New Haven, CT, United States.
4
Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States. Electronic address: ilse.wiechers@yale.edu.
5
Cornell Scott-Hill Health Center, New Haven, CT, United States.
6
Division of Population Health, Health Services Research & Primary Care, University of Manchester School of Health Sciences, Manchester, United Kindom.
7
Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, United States; Robert Wood Johnson Clinical Scholars Program, Yale School of Medicine, New Haven, CT, United States; Department of Health Policy, Yale School of Public Health, New Haven, CT, United States. Electronic address: steven.bernstein@yale.edu.
8
Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, United States; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT, United States. Electronic address: Arjun.venkatesh@yale.edu.

Abstract

BACKGROUND:

Patients newly insured through coverage expansion under the Affordable Care Act (ACA) may have difficulty obtaining timely primary care follow-up appointments after emergency department (ED) discharge. We evaluated the association between availability of timely follow-up appointment with practice access improvements, including patient-centered medical home (PCMH) designations or extended-hours appointments.

METHODS:

We performed a secret-shopper audit of primary care practices in greater New Haven, Connecticut. Two callers, posing as patients discharged from the ED, called these practices requesting follow-up appointments. They followed standardized scripts varying in ED diagnosis (uncontrolled hypertension, acute back pain) and insurance status (commercial, exchange, Medicaid). We linked our findings with data from a previously completed survey that assessed practice characteristics and examined the associations between appointment availability and practice access improvements.

RESULTS:

Of the 58 included primary care practices, 49 (84.5%) completed both the audit and the survey. Overall, 167/536 calls (31.2%) obtained an appointment in 7days. Practices with PCMH designation were less likely to offer appointments within 7days (23.4% vs. 33.1%, p=0.03). However, callers were more likely to obtain an appointment in 7days from practices offering after-hour appointments (36.3% vs. 27.8%, p=0.04). After adjusting for insurance type, there were no significant associations between practice improvements and 7-day appointment availability or appointment wait time.

CONCLUSION:

PCMH designation and extended-hours appointments were not associated with improved availability of timely primary care follow-up appointment for discharged ED patients. EDs should engage local clinicians and other stakeholders to strengthen linkage and care transition with outpatient practices.

KEYWORDS:

Access to health care; Emergency department; Patient-centered care

PMID:
29452920
DOI:
10.1016/j.ajem.2018.01.070

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