Comparing Follow-Up Recommendations and Attendance among Older Adults after Emergency Department Discharge

Document Type

Conference Proceeding

Publication Date

5-13-2025

Publication Title

Acad Emerg Med

Keywords

adult, Charlson Comorbidity Index, cohort analysis, conference abstract, controlled study, emergency ward, female, follow up, human, major clinical study, male, Michigan, patient attendance, primary medical care, race, retrospective study, special situation for pharmacovigilance

Abstract

Background and Objectives: Evidence from national cohorts suggests around 40% of patients attend an ED follow-up visit within 7 days, yet these studies do not account for whether follow-up was recommended or or the advised time frames. Our objective was to describe the distribution of time frames in which ED providers recommend primary care provider (PCP) follow-up and the frequency with which patients attend follow-up visits in this time frame. Methods: This is a retrospective study of patients age ≥65 discharged home from 9 EDs in Michigan during 7 periods in 2024. The primary outcome was adherence to follow-up as recommended by the ED provider, defined as patient attendance at PCP appointment(s) in the time frame recommended by the ED provider. Four abstractors reviewed charts (20% independent dual review). PCP clinics/patients were called for those with missing follow-up data. Analysis included descriptive statistics and logistic regression. Results: Of 675 total patients, median age was 74 (IQR 69-82), 61.0% female, and 25.3% black. Overall, 87.9% of patients were recommended PCP follow-up, with specified time frames of 1-3 days (49.2%), 4-7 days (13.7%), no specific time (20.8%), ASAP (11.9%), and as needed (4.4%). Significant predictors of providers recommending short-term follow-up were increased age (aOR 1.03 96% CI 1.01-1.06) and ED site. Race, sex, training status of the discharging provider, and Charlson comorbidity index were not predictors. The overall rate of PCP follow-up attendance in the recommended time frame was 26.9%. Only 11.7% of patients who were recommended follow-up within 3 days attended in that time. Regardless of PCP follow- up recommendations, 12.1% attended follow-up within 3 days, 24.3% within one week, 50.5% within 30 days, and 72.4% within 90 days of ED discharge. There was significant variation in rates of visit attendance at 7 days between sites (11.6% lowest versus 34.5% highest, p < 0.05). The median time to first PCP visit attendance after ED discharge was 20 days (IQR 6-64). Conclusion: A quarter of patients discharged from the ED attended PCP follow-up visits in the time frame recommended by the ED provider. There was a particularly low rate of PCP visit attendance within 3 days, despite nearly half of patients receiving this recommendation. Further research is needed to understand variation in follow-up recommendations, optimal timing of follow-up and solutions to fill care gaps after ED discharge.

Volume

32

Issue

S1

First Page

205

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