title: Impact of an internet-based emergency department appointment system to access primary care at safety net community clinics.
abstract: OBJECTIVE
  We evaluate the effect of an Internet-based, electronic referral system (termed IMPACT-ED for Improving Medical home and Primary care Access to the Community clinics Through the ED) on access and follow-up at primary care community clinics for safety net emergency department (ED) patients.
  
  
  METHODS
  We conducted a nonblinded interventional trial at an urban, safety net, hospital ED with a census of 39,000 annually. IMPACT-ED identified patients who had no source of regular care and lived in a 15-ZIP-code low-income area served by 3 community clinics. Emergency physicians received an automated notification through the electronic medical record to access an imbedded software program for scheduling follow-up clinic appointments. Patients who would benefit from a follow-up clinic visit within 2 weeks as determined by the emergency physician received a computer-generated appointment time and clinic map with bus routes as part of their discharge instructions, and the clinics received an electronic notification of the appointment. We compared frequency of follow-up for a 6-month period before implementation when patients received written instructions to call the clinic on their own (pre-IMPACT) and 6 months after implementation (post-IMPACT). Statistical analysis was conducted with chi(2) testing, and corresponding 95% confidence intervals are presented.
  
  
  RESULTS
  There were 326 patients who received an appointment (post-IMPACT), of whom 81 followed up at the clinic as directed (24.8%), compared with 399 patients who received a referral (pre-IMPACT), of whom 4 followed up as directed (1.0%), for an absolute improvement of 23.8% (95% confidence interval 19.1% to 28.6%).
  
  
  CONCLUSIONS
  Although most patients still failed to follow up at the community clinics as directed, the use of an Internet-based scheduling program linking a safety net ED with local community clinics significantly improved the frequency of follow-up for patients without primary care.
authors.affiliation: Department of Emergency Medicine, University of California San Diego Medical Center and School of Medicine, San Diego, CA, USA. tcchan@ucsd.edu
authors.forename: Theodore C
authors.initials: TC
authors.lastname: Chan
authors.forename: James P
authors.initials: JP
authors.lastname: Killeen
authors.forename: Edward M
authors.initials: EM
authors.lastname: Castillo
authors.forename: Gary M
authors.initials: GM
authors.lastname: Vilke
authors.forename: David A
authors.initials: DA
authors.lastname: Guss
authors.forename: Roberta
authors.initials: R
authors.lastname: Feinberg
authors.forename: Lawrence
authors.initials: L
authors.lastname: Friedman
mesh_terms: D001071:Appointments and Schedules; D016009:Chi-Square Distribution; D003153:Community Health Services / Q000706:statistics & numerical data*; D003266:Continuity of Patient Care; D004636:Emergency Service, Hospital; D006297:Health Services Accessibility; D006302:Health Services Research; D006786:Hospitals, Urban; D006801:Humans; D020407:Internet; D016015:Logistic Models; D011320:Primary Health Care; D012017:Referral and Consultation