• Benjamin A Palleiko, Jeremy V Lynn, Angie H Achkar, Tamera Hart-Johnson, Marcia A Perry, and R Alexander Blackwood.
• Office for Health Equity and Inclusion, University of Michigan, Ann Arbor, Michigan.
• J Emerg Med. 2020 Apr 1; 58 (4): 594-602.

BackgroundOutpatient referrals constitute a critical component of emergency medical care. However, barriers to care after emergency department (ED) visits have not been investigated thoroughly.ObjectiveThe purpose of this study was to determine the impact of sociodemographic variables on referral attendance after ED visits.MethodsA retrospective cohort study was designed. Patients aged 0-17 years who visited the C.S. Mott Children's Hospital ED in 2016 and received a referral were included. Multiple referrals for 1 patient were counted as independent encounters for statistical analysis.ResultsChart review was performed on 6120 pediatric ED encounters, producing a total of 822 referrals to University of Michigan Health System outpatient clinics. Referral attendance did not differ by race, ethnicity, language, or religion. Older age was associated with decreased attendance at referrals (p = 0.043). Patients who were black and female (p = 0.019), patients with public health insurance (p = 0.004), and patients residing in areas with either high rates of unemployment (p = 0.003), or lower high school education rates (p = 0.006) demonstrated decreased attendance. Patients referred to pediatric neurology had lower attendance rates (p < 0.001), and those referred to pediatric orthopedic surgery attended referrals more often (p = 0.006).ConclusionsThis study provides an overview of the impact of sociodemographic and departmental factors on attendance at outpatient follow-up referrals. Significant disparities exist with respect to referral attendance after emergency medical care. Informed resource allocation may be utilized to improve care for these at-risk patient populations.Copyright © 2019 Elsevier Inc. All rights reserved.

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