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An Intervention Connecting Low-Acuity Emergency Department Patients With Primary Care: Effect on Future Primary Care Linkage - 20/02/13

Doi : 10.1016/j.annemergmed.2012.10.021 
Kelly M. Doran, MD a, Ashley C. Colucci, BS b, Robert A. Hessler, MD, PhD b, Calvin K. Ngai, BA b, Nicholas D. Williams, MA, PhDc b, Andrew B. Wallach, MD c, Michael Tanner, MD c, Machelle H. Allen, MD d, Lewis R. Goldfrank, MD b, Stephen P. Wall, MD, MSc b,
a Robert Wood Johnson Foundation Clinical Scholars Program, Yale University School of Medicine and the US Department of Veterans Affairs, New Haven, CT 
b Department of Emergency Medicine at Bellevue Hospital Center and NYU School of Medicine, New York, NY 
c Division of General Internal Medicine at Bellevue Hospital Center and NYU School of Medicine, New York, NY 
d Department of Obstetrics and Gynecology at Bellevue Hospital Center and NYU School of Medicine, New York, NY 

Address for correspondence: Stephen P. Wall, MD, MSc

Résumé

Study objective

Our objective is to determine whether a point-of-care intervention that navigates willing, low-acuity patients from the emergency department (ED) to a Primary Care Clinic will increase future primary care follow-up.

Methods

We conducted a quasi-experimental trial at an urban safety net hospital. Adults presenting to the ED for select low-acuity problems were eligible. Patients were excluded if arriving by emergency medical services, if febrile, or if the triage nurse believed they required ED care. We enrolled 965 patients. Navigators escorted a subset of willing participants to the Primary Care Clinic (in the same hospital complex), where they were assigned a personal physician, were given an overview of clinic services, and received same-day clinic care. The primary outcome was Primary Care Clinic follow-up within 1 year of the index ED visit among patients having no previous primary care provider.

Results

In the bivariate intention-to-treat analysis, 50.3% of intervention group patients versus 36.9% of control group patients with no previous primary care provider had at least 1 Primary Care Clinic follow-up visit in the year after the intervention. In the multivariable analysis, the absolute difference in having at least 1 Primary Care Clinic follow-up for the intervention group compared with the control group was 9.3% (95% confidence interval 2.2% to 16.3%). There was no significant difference in the number of future ED visits.

Conclusion

A point-of-care intervention offering low-acuity ED patients the opportunity to alternatively be treated at the hospital's Primary Care Clinic resulted in increased future primary care follow-up compared with standard ED referral practices.

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Plan


 Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). The authors have stated that no such relationships exist. The Primary Care Access Project was supported by a grant from The Commonwealth Fund. The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and the preparation, review, or approval of the article.
 Please see page 313 for the Editor's Capsule Summary of this article.
 Author contributions: ACC, RAH, ABW, MT, MHA, and LRG conceived of the study and designed the trial. RAH, MHA, and LRG obtained funding. RAH and LRG provided study supervision. KMD, ACC, and CKN participated in data acquisition and management. KMD, ACC, NDW, and SPW analyzed and interpreted the data. SPW performed statistical analysis. KMD and SPW drafted the article, and all authors provided critical revision of it. SPW had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. SPW takes responsibility for the paper as a whole.
 Supervising editor: Michael J. Schull, MD, MSc
 A 9GLG3KV survey is available with each research article published on the Web at www.annemergmed.com.
 A podcast for this article is available at www.annemergmed.com.
 An incorrect version of Figure 2 was included in this article while online between December 19, 2012, and January 8, 2013.
 Publication date: Available online December 19, 2012.


© 2012  American College of Emergency Physicians. Publié par Elsevier Masson SAS. Tous droits réservés.
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Vol 61 - N° 3

P. 312 - mars 2013 Retour au numéro
Article précédent Article précédent
  • The Effect of an Ambulance Diversion Ban on Emergency Department Length of Stay and Ambulance Turnaround Time
  • Laura G. Burke, Nina Joyce, William E. Baker, Paul D. Biddinger, K. Sophia Dyer, Franklin D. Friedman, Jason Imperato, Alice King, Thomas M. Maciejko, Mark D. Pearlmutter, Assaad Sayah, Richard D. Zane, Stephen K. Epstein
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  • Continuing Care for Patients Choosing the Emergency Department as a Site for Primary Care: Feasibility, Benefits, and EMTALA Considerations
  • David L. Schriger, Tyler W. Barrett

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