Department of Emergency Medicine, Yale School of Medicine, New Haven, CT.
Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, CT.
Ann Emerg Med. 2018 Apr;71(4):487-496.e1. doi: 10.1016/j.annemergmed.2017.08.045. Epub 2017 Oct 9.
We examine the availability of follow-up appointments for emergency department (ED) patients without established primary care by insurance and clinical condition.
We used "secret shopper" methodology, employing 2 black men to telephone all 53 primary care practices in greater New Haven, posing as new patients discharged from the ED and requesting follow-up appointments. Each practice received 6 scripted calls from each caller during an 8-month period, reflecting all possible scenarios based on 3 insurance types (Medicaid, state exchange, and commercial) and 2 conditions (hypertension and back pain). Primary outcome was the proportion of calls that obtained an appointment in 7 calendar days (7-day appointment rate). Secondary outcomes included overall appointment rate and appointment wait time.
Among the total of 604 calls completed, the 7-day appointment rate was 30.7% (95% confidence interval [CI] 22.6% to 38.8%). Compared with commercial insurance, Medicaid calls had lower 7-day rate (25.5% versus 35.7%; difference 10.2%; 95% CI 2.2% to 18.1%) and overall appointment rate (53.5% versus 77.8%; difference 24.4%; 95% CI 13.4% to 35.4%). There was no significant difference between state exchange and commercial insurance calls in 7-day rate (30.9% versus 35.7%; difference 4.8%; 95% CI -3.1% to 12.6%) or overall appointment rate (73.4% versus 77.8%; difference 4.4%; 95% CI -2.7% to 11.6%). Back pain, compared with hypertension, had lower 7-day appointment rate (27.6% versus 33.7%; difference 6.1%; 95% CI 1.0% to 11.2%), but no significant difference in overall appointment rates (67.0% versus 69.4%; difference 2.4%; 95% CI -2.7% to 7.5%).
For patients without established primary care, obtaining timely follow-up after acute care in the ED is difficult, particularly for Medicaid beneficiaries.
我们通过保险和临床状况检查了急诊（ED）患者是否能获得后续预约。
我们使用了“秘密顾客”方法，雇用了 2 名黑人男子，以新患者身份从 ED 出院并要求预约，给纽黑文大都市区内的 53 个初级保健诊所打电话。每个诊所都在 8 个月的时间内收到了每个来电者的 6 次脚本呼叫，根据 3 种保险类型（医疗补助、州交换和商业）和 2 种情况（高血压和背痛）反映了所有可能的情况。主要结果是在 7 个日历日内获得预约的电话比例（7 天预约率）。次要结果包括总体预约率和预约等待时间。
在完成的总共 604 个电话中，7 天预约率为 30.7%（95%置信区间[CI] 22.6%至 38.8%）。与商业保险相比，医疗补助电话的 7 天预约率较低（25.5%比 35.7%；差异 10.2%；95%CI 2.2%至 18.1%）和整体预约率（53.5%比 77.8%；差异 24.4%；95%CI 13.4%至 35.4%）。州交换和商业保险电话在 7 天预约率（30.9%比 35.7%；差异 4.8%；95%CI -3.1%至 12.6%）或整体预约率（73.4%比 77.8%；差异 4.4%；95%CI -2.7%至 11.6%）方面无显著差异。与高血压相比，背痛的 7 天预约率较低（27.6%比 33.7%；差异 6.1%；95%CI 1.0%至 11.2%），但总体预约率无显著差异（67.0%比 69.4%；差异 2.4%；95%CI -2.7%至 7.5%）。
对于没有固定初级保健医生的患者来说，在 ED 接受急性治疗后，很难获得及时的后续治疗，特别是对医疗补助的受益人而言。
