title: Caregiver adherence to follow-up after an emergency department visit for common pediatric illnesses: Impact on future ED use.
abstract: BACKGROUND
  Access to primary care is often a problem for children living in urban areas and the rate of emergency department (ED) use can be high. For acute childhood illnesses, primary care follow-up is often recommended to prevent subsequent ED visits.
  
  
  METHODS
  We conducted an observational study of 455 children with common childhood illnesses, between 6 weeks and 8 years of age, presenting to 1 of 3 EDs, and discharged to the community. ED physicians recommended that the child visit their primary care physician within 1 to 4 days of discharge (ie, "short-term" follow-up). Caregivers were surveyed during the ED index visit and after discharge to assess primary care follow-up adherence. We collected data on child and caregiver characteristics, type and severity of illness at the ED index visit, and ED return visits in the 2-month period after the ED index visit.
  
  
  RESULTS
  A total of 45.3% of caregivers adhered to short-term primary care follow-up. Short-term follow-up adherence was associated with greater ED use for the same illness over the subsequent 2 months (odds ratio = 2.97; 95% confidence interval, 1.31-6.72). Subsequent ED use was greatest for children with short-term primary care follow-up and: (1) prior ED use, (2) single caregivers, (3) mild severity illnesses at the ED index visit, or (4) younger children. ED use after the initial visit did not vary by type of illness or site.
  
  
  CONCLUSIONS
  There was no evidence that primary care follow-up soon after an ED visit was associated with a lower rate of subsequent ED use for common pediatric illnesses.
authors.affiliation: VA Ann Arbor Healthcare System, Center for Clinical Management Research, USA. magregor@umich.edu
authors.forename: Mary Ann
authors.initials: MA
authors.lastname: Gregor
authors.forename: John R C
authors.initials: JR
authors.lastname: Wheeler
authors.forename: Rachel M
authors.initials: RM
authors.lastname: Stanley
authors.forename: Prashant V
authors.initials: PV
authors.lastname: Mahajan
authors.forename: Ronald F
authors.initials: RF
authors.lastname: Maio
authors.forename: John D
authors.initials: JD
authors.lastname: Piette
mesh_terms: D001249:Asthma / Q000175:diagnosis / Q000628:therapy*; D001988:Bronchiolitis / Q000175:diagnosis / Q000628:therapy*; D017028:Caregivers / Q000145:classification / Q000523:psychology* / Q000706:statistics & numerical data; D002648:Child; D002662:Child Health Services / Q000706:statistics & numerical data*; D002675:Child, Preschool; D003266:Continuity of Patient Care; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005759:Gastroenteritis / Q000175:diagnosis / Q000628:therapy*; D019538:Health Care Surveys; D006801:Humans; D007223:Infant; D019458:Insurance Coverage; D016015:Logistic Models; D008824:Michigan; D010290:Parents / Q000523:psychology*; D010349:Patient Compliance / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000706:statistics & numerical data*; D012041:Regional Medical Programs; D012307:Risk Factors; D012720:Severity of Illness Index