title: Low rates of follow-up with primary care providers after pediatric emergency department visits for respiratory tract illnesses.
abstract: OBJECTIVE
  We sought to determine diagnosis-specific rates of follow-up with primary care providers (PCPs) after emergency department (ED) visits for respiratory tract illnesses. We hypothesized that follow-up rates would be higher among patients with acute infectious illnesses than among those with asthma.
  
  
  METHODS
  This was a retrospective cohort study of a random sample of patients aged 0 to 12 years discharged over a 12-month period from an urban, tertiary care pediatric ED with 4 different respiratory tract illnesses (asthma, bronchiolitis, croup, and pneumonia). Primary care provider follow-up was examined for associations with sociodemographic and clinical factors and with subsequent ED visits.
  
  
  RESULTS
  Rates of follow-up in the overall cohort were low: 23.6% (95% confidence interval, 19.7-27.4) by 7 days and 40.5% (95% confidence interval, 36.0-44.9) by 30 days. Compared with patients with asthma, the relative risks (RRs) of follow-up within 7 and 30 days were significantly higher among patients with bronchiolitis and pneumonia, but not with croup. For the cohort as a whole, the RR of follow-up within 7 and 30 days significantly decreased for each 1-year increase in age, and the RR of follow-up within 7 days significantly increased with the provision of explicit ED discharge instructions recommending follow-up. Among patients with asthma, follow-up with PCPs within 30 days was not associated with decreased ED visits for asthma over the following year.
  
  
  CONCLUSIONS
  Rates of PCP follow-up were globally low but significantly higher for patients with acute infectious illnesses, for younger patients, and for those receiving explicit ED discharge instructions.
authors.affiliation: Division of Emergency and Transport Medicine, Children's Hospital Los Angeles, Los Angeles, CA 90027, USA. dliberman@chla.usc.edu
authors.forename: Danica B
authors.initials: DB
authors.lastname: Liberman
authors.forename: Deborah Q
authors.initials: DQ
authors.lastname: Shelef
authors.forename: Jianping
authors.initials: J
authors.lastname: He
authors.forename: Robert
authors.initials: R
authors.lastname: McCarter
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Teach
mesh_terms: D002648:Child; D002675:Child, Preschool; D003266:Continuity of Patient Care; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011320:Primary Health Care / Q000379:methods*; D012140:Respiratory Tract Diseases / Q000453:epidemiology / Q000628:therapy*; D012189:Retrospective Studies; D013997:Time Factors