• Am J Emerg Med · Jul 2016

    Transitional care clinics for follow-up and primary care linkage for patients discharged from the ED.

    • Kailyn Elliott, Jared W Klein, Anirban Basu, and Amber K Sabbatini.
    • Division of Emergency Medicine, University of Washington, Seattle, WA 98104. Electronic address: kailyne@uw.edu.
    • Am J Emerg Med. 2016 Jul 1; 34 (7): 1230-5.

    ObjectivesTransitional care clinics (TCCs) represent one strategy to facilitate follow-up and primary care linkage for patients with no regular source of care who are discharged from the emergency department (ED). We assessed factors associated with completion of TCC follow-up among these patients and characterized their subsequent ED use.MethodsRetrospective study of 660 randomly sampled patients with a scheduled appointment to a TCC at time of ED discharge. Patient- and visit-level characteristics were abstracted from the medical records of these patients and linked to a state visit database to characterize ED use after referral. Multiple logistic regression was used to determine factors associated with completion of follow-up and subsequent ED utilization.ResultsHalf (50%) of the patients completed their follow-up appointment with a mean follow-up time of 6.9days. Non-English language (odds ratio [OR], 2.21; confidence interval [CI], 1.30-3.75) was the only factor associated with improved follow-up; however, patients who were homeless (OR, 0.42; CI, 0.26-0.66) had a substance use history (OR, 0.68; CI, 0.45-1.00), and those with more baseline ED visits (OR, 0.94 per additional ED visit; CI, 0.89-0.99) were significantly less likely to complete follow-up. After adjusting for demographic, clinical, and visit-level characteristics, patients who completed their appointment had significantly fewer ED visits in the subsequent year compared to patients who did not complete their appointment (mean, 2.3 vs 3.3 visits; difference, -1.0 visits in subsequent calendar year; CI for difference, -1.2 to -0.7).ConclusionTransitional care clinics represent a promising strategy to improve the continuity of care for emergency patients and may reduce unnecessary ED use.Published by Elsevier Inc.

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