title: Barriers to outpatient stress testing follow-up for low-risk chest pain patients presenting to an ED chest pain unit.
abstract: BACKGROUND
  Outpatient stress testing (OST) after evaluation in the emergency department (ED) is an acceptable evaluation method for patients presenting to the ED with low-risk chest pain (CP). However, not all patients return for OST. Barriers to follow-up evaluation exist and are poorly understood. In this study, we examined the influence of demographic and social characteristics on OST compliance.
  
  
  METHODS
  Data were collected on low-risk CP patients with scheduled OSTs. OST compliance was assessed and then analyzed for correlation with potential barriers including insurance type; age; sex; race; employment status; the distance the patient lived from the hospital; whether or not the patient had a primary care physician; whether or not the patient had a history of hypertension or diabetes; and whether or not the patient had a history of tobacco, alcohol, or illicit drug use.
  
  
  RESULTS
  A total of 275 patients were enrolled over a 5-month period. These patients had an OST follow-up rate of 61.82% within 72hours of discharge from the ED. Patients with Medicaid were statistically less likely (odds ratio [OR], 0.439) to complete OST. Patients with commercial insurance (OR, 1.8225), who were employed (OR, 2.299), or who were retired (OR, 3.44) were more likely to complete OST. All of the other variables analyzed were not statistically significant factors in OST compliance.
  
  
  CONCLUSIONS
  More than one-third of low-risk CP patients do not follow-up with scheduled OST. Of the variables analyzed, both employment status and insurance type were statistically significant and should be included in risk stratification strategies for OST.
authors: Department of Emergency Medicine and Hospitalist Services, Medical College of Georgia at Georgia Regents University, Augusta, GA.
authors: Margaret
authors: M
authors: Story
authors: Department of Emergency Medicine and Hospitalist Services, Medical College of Georgia at Georgia Regents University, Augusta, GA.
authors: Bradford
authors: B
authors: Reynolds
authors: Department of Emergency Medicine and Hospitalist Services, Medical College of Georgia at Georgia Regents University, Augusta, GA.
authors: Meghan
authors: M
authors: Bowser
authors: Department of Biostatistics and Epidemiology, Medical College of Georgia, Georgia Regents University, Augusta, GA.
authors: Hongyan
authors: H
authors: Xu
authors: The Medical College of Georgia at Georgia Regents University, 1120 15th Street, AF 2020, Augusta, GA, USA 30912. Electronic address: mlyon@gru.edu.
authors: Matthew
authors: M
authors: Lyon
mesh_terms: D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D002637:Chest Pain; D004636:Emergency Service, Hospital; D004651:Employment; D005080:Exercise Test / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006297:Health Services Accessibility; D006801:Humans; D007348:Insurance, Health; D008297:Male; D008484:Medicaid; D008875:Middle Aged; D010349:Patient Compliance / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012306:Risk; D014481:United States