University of Wisconsin–Madison Medical College of Wisconsin

Factors Influencing Show Rates of Emergency Department Referrals to Primary Care Safety Net Clinics

Miranda Brown, BS; Gregory Stadter, MPH; Michael C. Decker, MD

Published online ahead of print April 29, 2022.

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ABSTRACT

Background: Utilization of emergency departments for non-urgent conditions has been a longstanding problem leading to excessive health care spending, unnecessary testing, and missed opportunities for patients to form longitudinal relationships with primary care clinicians. The Milwaukee Health Care Partnership established the Emergency Department Care Coordination program to decrease avoidable emergency department visits and connect high-risk individuals with primary care medical homes. Emergency department providers from 8 hospitals schedule patients to safety net clinics to establish follow-up care. During 2018 and 2019, there were 5,035 appointments scheduled, with a 43% show rate. This project aimed to identify factors influencing the show rate to follow-up appointments and to develop program interventions.

Methods: This project utilized a database of deidentified patient and referral information and performed logistic regressions to determine factors that influence show rates.

Results: There was a significant difference in show rates when looking at days between the emergency department visit and follow-up appointment, age, receiving clinic, and insurance status (all P > 0.001). Patients seen within 5 days of emergency department visit, patients 65 and older, and uninsured patients had increased likelihood of attending follow-up appointments.

Conclusion: These results demonstrate that older adults are more likely to attend appointments, and more efforts are needed to engage younger people. The analysis shows the need to schedule patients with follow-up primary care quickly, as a short number of days from emergency department visit to primary care appointment was strongly correlated with a higher show rate. In addition, uninsured patients are good candidates for Emergency Department Care Coordination program referrals.


Author Affiliations: Medical College of Wisconsin, Wauwatosa, Wisconsin (Brown, Decker); Milwaukee Health Care Partnership, Milwaukee, Wisconsin (Stadter).
Corresponding Author: Miranda Brown; email mirbrown@mcw.edu; ORCID ID 0000-0002-0212-5777.
Acknowledgements: Thanks to the Medical College of Wisconsin Biostatistics department and the organizations participating in the Emergency Department Care Coordination program – the EDs at Ascension (Columbia St. Mary’s, St. Francis, St. Joseph), Advocate Aurora (St. Luke’s, Sinai, South Shore, West Allis) and Froedtert, and the Federally Qualified Health Centers in Milwaukee (Ignace, Milwaukee Health Services, Outreach, Progressive, Sixteenth Street).
Funding/Support: None declared.
Financial Disclosures: None declared.
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