title: Incident atrial fibrillation in the emergency department in Ontario: a population-based retrospective cohort study of follow-up care.
abstract: BACKGROUND
  Continuity of care has been shown to be poor following in-hospital discharge, and there are substantially fewer resources to facilitate follow-up care arrangements after discharge from an emergency department. Our objective was to assess the frequency, timeliness and predictors for obtaining follow-up care following discharge from an emergency department in Ontario with a new diagnosis of atrial fibrillation.
  
  
  METHODS
  We conducted a retrospective cohort study involving all patients discharged from the 157 nonpediatric emergency departments in Ontario, who received a new diagnosis of atrial fibrillation between 2007 and 2012. We determined the frequency of follow-up care with a family physician, cardiologist or internist within 7 (timely) and 30 days of the emergency department visit, and assessed the association of emergency and family physician characteristics, including primary care model type, with obtaining timely follow-up care.
  
  
  RESULTS
  Among 14 907 patients discharged from Ontario emergency departments with a new, primary diagnosis of atrial fibrillation, half (n = 7473) had timely follow-up care. At 30 days, 2678 patients (18.0%) still had not obtained follow-up care. Among emergency and family physician factors, lack of a family physician had the largest independent association with acquiring timely follow-up care (odds ratio [OR] 0.58, 95% confidence interval [CI] 0.50-0.69). Using patients with a family physician belonging to a primarily fee-for-service remuneration model as the comparison group, patients with a family physician belonging to a capitation-based Family Health Network, as part of a Family Health Team, were less likely to receive timely follow-up care (OR 0.73, 95% CI 0.62-0.86), as were those whose family physician belonged to the same model type that was not part of a Family Health Team (OR 0.77, 95% CI 0.60-0.97).
  
  
  CONCLUSIONS
  Only half of the patients who were discharged from an emergency department in Ontario with a new diagnosis of atrial fibrillation were seen within 7 days of discharge. The most influential factor was having a family physician; patients with a family physician being remunerated via primarily fee-for-service methods were more likely to be seen within 7 days than those who were reimbursed through a primarily capitation model. Systems-wide solutions are needed to ensure timely follow-up care is available for all patients with chronic diseases.
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Ont. ; Division of Emergency Medicine, University of Toronto, Toronto, Ont. ; Sunnybrook Health Sciences Centre, Toronto, Ont.
authors.forename: Clare L
authors.initials: CL
authors.lastname: Atzema
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Ont.
authors.forename: Bing
authors.initials: B
authors.lastname: Yu
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Ont. ; Department of Medicine, Department of Family Medicine, University of Toronto, Toronto, Ont. ; Women's College Hospital, Toronto, Ont.
authors.forename: Noah
authors.initials: N
authors.lastname: Ivers
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Ont. ; Division of Geriatric Medicine, University of Toronto, Toronto, Ont. ; Women's College Hospital, Toronto, Ont.
authors.forename: Paula
authors.initials: P
authors.lastname: Rochon
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Ont. ; Division of Cardiology, University of Toronto, Toronto, Ont. ; University Health Network, Toronto, Ont.
authors.forename: Douglas S
authors.initials: DS
authors.lastname: Lee
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Ont. ; Division of Emergency Medicine, University of Toronto, Toronto, Ont. ; Sunnybrook Health Sciences Centre, Toronto, Ont.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Schull
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Ont.
authors.forename: Peter C
authors.initials: PC
authors.lastname: Austin