BACKGROUND: Emergency department (ED) patients often need urgent primary or specialty care follow-up, but access is particularly difficult for those without insurance. OBJECTIVE: To characterize follow-up options for uninsured ED patients and to evaluate differences based on ED characteristics. METHODS: We mailed a survey to all ED Directors in Colorado, Georgia, Massachusetts, and Oregon (n = 351 EDs). Typical referrals for urgent primary and specialty care follow-up for uninsured patients were classified as: a) private physician or clinic affiliated with the same hospital; b) external public clinic or university hospital; or c) no referral system/policy. RESULTS: Of the 298 (85%) responding EDs, 215 (72%) reported primary care referral to private physicians or clinics at the same hospital and 231 (78%) for specialty care. Twenty (7%) and 27 (9%) EDs had no referral system for primary and specialty care, respectively. Factors associated with typical referral to primary care follow-up at the same hospital were: lower visit volume (85% for EDs with < 1 patient per hour vs. 67% for EDs with ≥ 3 patients per hour); rural area (79% for rural vs. 68% for urban areas), and critical access hospital status (81% critical access vs. 69% non-critical access). Conversely, higher visit volume (87% vs. 58%), urban (81% vs. 72%), and non-critical access hospitals (83% vs. 53%) were more likely to refer for specialty care follow-up at the same hospital. CONCLUSION: Referral of uninsured ED patients to local follow-up was high for primary and specialty care. Smaller, rural EDs referred within their own hospital more often for primary care but less often for specialty care.
BACKGROUND: Emergency department (ED) patients often need urgent primary or specialty care follow-up, but access is particularly difficult for those without insurance. OBJECTIVE: To characterize follow-up options for uninsured ED patients and to evaluate differences based on ED characteristics. METHODS: We mailed a survey to all ED Directors in Colorado, Georgia, Massachusetts, and Oregon (n = 351 EDs). Typical referrals for urgent primary and specialty care follow-up for uninsured patients were classified as: a) private physician or clinic affiliated with the same hospital; b) external public clinic or university hospital; or c) no referral system/policy. RESULTS: Of the 298 (85%) responding EDs, 215 (72%) reported primary care referral to private physicians or clinics at the same hospital and 231 (78%) for specialty care. Twenty (7%) and 27 (9%) EDs had no referral system for primary and specialty care, respectively. Factors associated with typical referral to primary care follow-up at the same hospital were: lower visit volume (85% for EDs with < 1 patient per hour vs. 67% for EDs with ≥ 3 patients per hour); rural area (79% for rural vs. 68% for urban areas), and critical access hospital status (81% critical access vs. 69% non-critical access). Conversely, higher visit volume (87% vs. 58%), urban (81% vs. 72%), and non-critical access hospitals (83% vs. 53%) were more likely to refer for specialty care follow-up at the same hospital. CONCLUSION: Referral of uninsured ED patients to local follow-up was high for primary and specialty care. Smaller, rural EDs referred within their own hospital more often for primary care but less often for specialty care.
Authors: Jessica R Schumacher; Barbara J Lutz; Allyson G Hall; Jeffrey S Harman; Kristen Turner; Babette A Brumback; Phyllis Hendry; Donna L Carden Journal: Med Care Date: 2021-01 Impact factor: 2.983
Authors: Frank Xavier Scheuermeyer; Eric Grafstein; Brian Rowe; Jay Cheyne; Brian Grunau; Aaron Bradford; Adeera Levin Journal: Can J Kidney Health Dis Date: 2017-04-12
Authors: Margaret Greenwood-Ericksen; Neil Kamdar; Paul Lin; Naomi George; Larissa Myaskovsky; Cameron Crandall; Nicholas M Mohr; Keith E Kocher Journal: JAMA Netw Open Date: 2021-11-01