Oostema John Adam, Mullennix Stephanie, Chassee Todd, Port Christopher, Deveau John, Throop John, Reynolds Joshua C
Corewell Health West Emergency Care Specialists Grand Rapids Michigan USA.
Department of Emergency Medicine Michigan State University Grand Rapids Michigan USA.
J Am Coll Emerg Physicians Open. 2024 Sep 12;5(5):e13302. doi: 10.1002/emp2.13302. eCollection 2024 Oct.
Many unscheduled return visits to the emergency department (ED) stem from insufficient access to outpatient follow-up. We piloted an emergency medicine-staffed, on-demand, virtual after care clinic (VACC) as an alternative for discharged ED patients.
Prospective cohort study of discharged ED patients who scheduled VACC appointments within 72 hours of index ED visit. We performed descriptive analyses and compared risks of ED return at 72 hours and 30 days between patients who did/did not attend their appointment.
From March to December 2022, 309 patients scheduled VACC appointments and 210 (68%) attended them. Patients who scheduled appointments were young (median 37 years), non-Hispanic white (80%), females (75%) with a primary care physicians (PCP) (90%), and commercial insurance (72%). Most VACC visits reinforced ED testing and/or treatment (64%) or adjusted medications (26%). VACC attendees were less likely to return to the ED within 72 h (3.3% vs. 13.1%; risk difference 9.3% [95% confidence interval, CI 2.7%‒19.8%]) and 30 days (16.2% vs. 30.3%; risk difference 14.1% [95% CI 3.8%‒24.4%]) compared to those who scheduled but did not attend a VACC appointment. VACC attendance was associated with lower odds of 72-h (adjusted odds ratio [aOR] 0.0; 95% CI 0.0‒0.4) and 30-day (aOR 0.4; 95% CI 0.2‒0.7) return ED visits.
In this pilot study, younger, white, female, commercially insured patients with a PCP preferentially scheduled VACC appointments. Among patients who scheduled VACC appointments, those who attended their appointments were less likely to return to the ED within 72 hours and 30 days than those who did not.
许多非计划内的急诊复诊源于门诊随访机会不足。我们试点了一个由急诊医学人员提供服务的、按需提供的虚拟后续护理诊所（VACC），作为急诊出院患者的一种替代选择。
对在首次急诊就诊后72小时内预约VACC就诊的急诊出院患者进行前瞻性队列研究。我们进行了描述性分析，并比较了预约就诊和未预约就诊患者在72小时和30天时的急诊复诊风险。
2022年3月至12月，309名患者预约了VACC就诊，其中210名（68%）前来就诊。预约就诊的患者较为年轻（中位年龄37岁），非西班牙裔白人（80%），女性（75%），有初级保健医生（PCP）（90%），且为商业保险（72%）。大多数VACC就诊强化了急诊检查和/或治疗（64%）或调整了药物（26%）。与预约但未就诊的患者相比，VACC就诊者在72小时内（3.3%对13.1%；风险差异9.3%[95%置信区间，CI 2.7%‒19.8%]）和30天内（16.2%对30.3%；风险差异14.1%[95% CI 3.8%‒24.4%]）返回急诊的可能性较小。VACC就诊与72小时（调整后的优势比[aOR] 0.0；95% CI 0.0‒0.4）和30天（aOR 0.4；95% CI 0.2‒0.7）返回急诊就诊的较低几率相关。
在这项试点研究中，有初级保健医生的年轻、白人、女性、商业保险患者优先预约了VACC就诊。在预约VACC就诊的患者中，就诊者在72小时和30天内返回急诊的可能性低于未就诊者。
