title: Transitional care clinics for follow-up and primary care linkage for patients discharged from the ED.
abstract: OBJECTIVE
  Transitional care clinics (TCCs) represent one strategy to facilitate follow-up and primary care linkage for patients with no regular source of care who are discharged from the emergency department (ED). We assessed factors associated with completion of TCC follow-up among these patients and characterized their subsequent ED use.
  
  
  METHODS
  Retrospective study of 660 randomly sampled patients with a scheduled appointment to a TCC at time of ED discharge. Patient- and visit-level characteristics were abstracted from the medical records of these patients and linked to a state visit database to characterize ED use after referral. Multiple logistic regression was used to determine factors associated with completion of follow-up and subsequent ED utilization.
  
  
  RESULTS
  Half (50%) of the patients completed their follow-up appointment with a mean follow-up time of 6.9days. Non-English language (odds ratio [OR], 2.21; confidence interval [CI], 1.30-3.75) was the only factor associated with improved follow-up; however, patients who were homeless (OR, 0.42; CI, 0.26-0.66) had a substance use history (OR, 0.68; CI, 0.45-1.00), and those with more baseline ED visits (OR, 0.94 per additional ED visit; CI, 0.89-0.99) were significantly less likely to complete follow-up. After adjusting for demographic, clinical, and visit-level characteristics, patients who completed their appointment had significantly fewer ED visits in the subsequent year compared to patients who did not complete their appointment (mean, 2.3 vs 3.3 visits; difference, -1.0 visits in subsequent calendar year; CI for difference, -1.2 to -0.7).
  
  
  CONCLUSIONS
  Transitional care clinics represent a promising strategy to improve the continuity of care for emergency patients and may reduce unnecessary ED use.
authors.affiliation: Division of Emergency Medicine, University of Washington, Seattle, WA 98104. Electronic address: kailyne@uw.edu.
authors.forename: Kailyn
authors.initials: K
authors.lastname: Elliott
authors.affiliation: Department of Medicine, University of Washington, Seattle, WA 98104. Electronic address: jaredwk@uw.edu.
authors.forename: Jared
authors.initials: J
authors.lastname: W Klein
authors.affiliation: Department of Health Services and Economics, University of Washington, Seattle, WA 98195-7630. Electronic address: basua@uw.edu.
authors.forename: Anirban
authors.initials: A
authors.lastname: Basu
authors.affiliation: Division of Emergency Medicine, University of Washington, Seattle, WA 98104. Electronic address: asabbati@uw.edu.
authors.forename: Amber K
authors.initials: AK
authors.lastname: Sabbatini
mesh_terms: D000293:Adolescent; D000328:Adult; D000359:Aftercare; D000368:Aged; D001071:Appointments and Schedules; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D010351:Patient Discharge; D011320:Primary Health Care; D012189:Retrospective Studies; D055815:Young Adult