Referral of discharged emergency department patients to primary and specialty care follow-up.
BACKGROUND
Emergency department (ED) patients often need urgent primary or specialty care follow-up, but access is particularly difficult for those without insurance.


OBJECTIVE
To characterize follow-up options for uninsured ED patients and to evaluate differences based on ED characteristics.


METHODS
We mailed a survey to all ED Directors in Colorado, Georgia, Massachusetts, and Oregon (n = 351 EDs). Typical referrals for urgent primary and specialty care follow-up for uninsured patients were classified as: a) private physician or clinic affiliated with the same hospital; b) external public clinic or university hospital; or c) no referral system/policy.


RESULTS
Of the 298 (85%) responding EDs, 215 (72%) reported primary care referral to private physicians or clinics at the same hospital and 231 (78%) for specialty care. Twenty (7%) and 27 (9%) EDs had no referral system for primary and specialty care, respectively. Factors associated with typical referral to primary care follow-up at the same hospital were: lower visit volume (85% for EDs with < 1 patient per hour vs. 67% for EDs with ≥ 3 patients per hour); rural area (79% for rural vs. 68% for urban areas), and critical access hospital status (81% critical access vs. 69% non-critical access). Conversely, higher visit volume (87% vs. 58%), urban (81% vs. 72%), and non-critical access hospitals (83% vs. 53%) were more likely to refer for specialty care follow-up at the same hospital.


CONCLUSIONS
Referral of uninsured ED patients to local follow-up was high for primary and specialty care. Smaller, rural EDs referred within their own hospital more often for primary care but less often for specialty care.
Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado 80045, USA.
Adit A
AA
Ginde
Brad E
BE
Talley
Stacy A
SA
Trent
Ali S
AS
Raja
Ashley F
AF
Sullivan
Carlos A
CA
Camargo
D001071:Appointments and Schedules; D003120:Colorado; D003266:Continuity of Patient Care; D003625:Data Collection; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005845:Georgia; D006297:Health Services Accessibility; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D008404:Massachusetts; D017057:Medically Uninsured / Q000706:statistics & numerical data*; D009922:Oregon; D011320:Primary Health Care / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000145:classification / Q000706:statistics & numerical data*; D019035:Rural Health Services / Q000706:statistics & numerical data; D013038:Specialization / Q000706:statistics & numerical data; D019037:Urban Health Services / Q000706:statistics & numerical data