Patient centered medical homes did not improve access to timely follow-up after ED visit

Shih Chuan Chou, Craig Rothenberg, Alicia Agnoli, Ilse Wiechers, Jason Lott, Jennifer Voorhees, Steven L. Bernstein, Arjun K. Venkatesh

Research output: Contribution to journalArticle

Abstract

Background: Patients newly insured through coverage expansion under the Affordable Care Act (ACA) may have difficulty obtaining timely primary care follow-up appointments after emergency department (ED) discharge. We evaluated the association between availability of timely follow-up appointment with practice access improvements, including patient-centered medical home (PCMH) designations or extended-hours appointments. Methods: We performed a secret-shopper audit of primary care practices in greater New Haven, Connecticut. Two callers, posing as patients discharged from the ED, called these practices requesting follow-up appointments. They followed standardized scripts varying in ED diagnosis (uncontrolled hypertension, acute back pain) and insurance status (commercial, exchange, Medicaid). We linked our findings with data from a previously completed survey that assessed practice characteristics and examined the associations between appointment availability and practice access improvements. Results: Of the 58 included primary care practices, 49 (84.5%) completed both the audit and the survey. Overall, 167/536 calls (31.2%) obtained an appointment in 7. days. Practices with PCMH designation were less likely to offer appointments within 7. days (23.4% vs. 33.1%, p = 0.03). However, callers were more likely to obtain an appointment in 7. days from practices offering after-hour appointments (36.3% vs. 27.8%, p = 0.04). After adjusting for insurance type, there were no significant associations between practice improvements and 7-day appointment availability or appointment wait time. Conclusion: PCMH designation and extended-hours appointments were not associated with improved availability of timely primary care follow-up appointment for discharged ED patients. EDs should engage local clinicians and other stakeholders to strengthen linkage and care transition with outpatient practices.

Original languageEnglish (US)
JournalAmerican Journal of Emergency Medicine
DOIs
StateAccepted/In press - Jan 1 2018
Externally publishedYes

Fingerprint

Patient-Centered Care
Hospital Emergency Service
Appointments and Schedules
Primary Health Care
Patient Protection and Affordable Care Act
Patient Transfer
Insurance Coverage
Medicaid
Acute Pain
Back Pain
Insurance

Keywords

  • Access to health care
  • Emergency department
  • Patient-centered care

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Patient centered medical homes did not improve access to timely follow-up after ED visit. / Chou, Shih Chuan; Rothenberg, Craig; Agnoli, Alicia; Wiechers, Ilse; Lott, Jason; Voorhees, Jennifer; Bernstein, Steven L.; Venkatesh, Arjun K.

In: American Journal of Emergency Medicine, 01.01.2018.

Research output: Contribution to journalArticle

Chou, Shih Chuan ; Rothenberg, Craig ; Agnoli, Alicia ; Wiechers, Ilse ; Lott, Jason ; Voorhees, Jennifer ; Bernstein, Steven L. ; Venkatesh, Arjun K. / Patient centered medical homes did not improve access to timely follow-up after ED visit. In: American Journal of Emergency Medicine. 2018.
@article{bc30d72a21374c78a80f109801d8edda,
title = "Patient centered medical homes did not improve access to timely follow-up after ED visit",
abstract = "Background: Patients newly insured through coverage expansion under the Affordable Care Act (ACA) may have difficulty obtaining timely primary care follow-up appointments after emergency department (ED) discharge. We evaluated the association between availability of timely follow-up appointment with practice access improvements, including patient-centered medical home (PCMH) designations or extended-hours appointments. Methods: We performed a secret-shopper audit of primary care practices in greater New Haven, Connecticut. Two callers, posing as patients discharged from the ED, called these practices requesting follow-up appointments. They followed standardized scripts varying in ED diagnosis (uncontrolled hypertension, acute back pain) and insurance status (commercial, exchange, Medicaid). We linked our findings with data from a previously completed survey that assessed practice characteristics and examined the associations between appointment availability and practice access improvements. Results: Of the 58 included primary care practices, 49 (84.5{\%}) completed both the audit and the survey. Overall, 167/536 calls (31.2{\%}) obtained an appointment in 7. days. Practices with PCMH designation were less likely to offer appointments within 7. days (23.4{\%} vs. 33.1{\%}, p = 0.03). However, callers were more likely to obtain an appointment in 7. days from practices offering after-hour appointments (36.3{\%} vs. 27.8{\%}, p = 0.04). After adjusting for insurance type, there were no significant associations between practice improvements and 7-day appointment availability or appointment wait time. Conclusion: PCMH designation and extended-hours appointments were not associated with improved availability of timely primary care follow-up appointment for discharged ED patients. EDs should engage local clinicians and other stakeholders to strengthen linkage and care transition with outpatient practices.",
keywords = "Access to health care, Emergency department, Patient-centered care",
author = "Chou, {Shih Chuan} and Craig Rothenberg and Alicia Agnoli and Ilse Wiechers and Jason Lott and Jennifer Voorhees and Bernstein, {Steven L.} and Venkatesh, {Arjun K.}",
year = "2018",
month = "1",
day = "1",
doi = "10.1016/j.ajem.2018.01.070",
language = "English (US)",
journal = "American Journal of Emergency Medicine",
issn = "0735-6757",
publisher = "W.B. Saunders Ltd",

}

TY - JOUR

T1 - Patient centered medical homes did not improve access to timely follow-up after ED visit

AU - Chou, Shih Chuan

AU - Rothenberg, Craig

AU - Agnoli, Alicia

AU - Wiechers, Ilse

AU - Lott, Jason

AU - Voorhees, Jennifer

AU - Bernstein, Steven L.

AU - Venkatesh, Arjun K.

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Background: Patients newly insured through coverage expansion under the Affordable Care Act (ACA) may have difficulty obtaining timely primary care follow-up appointments after emergency department (ED) discharge. We evaluated the association between availability of timely follow-up appointment with practice access improvements, including patient-centered medical home (PCMH) designations or extended-hours appointments. Methods: We performed a secret-shopper audit of primary care practices in greater New Haven, Connecticut. Two callers, posing as patients discharged from the ED, called these practices requesting follow-up appointments. They followed standardized scripts varying in ED diagnosis (uncontrolled hypertension, acute back pain) and insurance status (commercial, exchange, Medicaid). We linked our findings with data from a previously completed survey that assessed practice characteristics and examined the associations between appointment availability and practice access improvements. Results: Of the 58 included primary care practices, 49 (84.5%) completed both the audit and the survey. Overall, 167/536 calls (31.2%) obtained an appointment in 7. days. Practices with PCMH designation were less likely to offer appointments within 7. days (23.4% vs. 33.1%, p = 0.03). However, callers were more likely to obtain an appointment in 7. days from practices offering after-hour appointments (36.3% vs. 27.8%, p = 0.04). After adjusting for insurance type, there were no significant associations between practice improvements and 7-day appointment availability or appointment wait time. Conclusion: PCMH designation and extended-hours appointments were not associated with improved availability of timely primary care follow-up appointment for discharged ED patients. EDs should engage local clinicians and other stakeholders to strengthen linkage and care transition with outpatient practices.

AB - Background: Patients newly insured through coverage expansion under the Affordable Care Act (ACA) may have difficulty obtaining timely primary care follow-up appointments after emergency department (ED) discharge. We evaluated the association between availability of timely follow-up appointment with practice access improvements, including patient-centered medical home (PCMH) designations or extended-hours appointments. Methods: We performed a secret-shopper audit of primary care practices in greater New Haven, Connecticut. Two callers, posing as patients discharged from the ED, called these practices requesting follow-up appointments. They followed standardized scripts varying in ED diagnosis (uncontrolled hypertension, acute back pain) and insurance status (commercial, exchange, Medicaid). We linked our findings with data from a previously completed survey that assessed practice characteristics and examined the associations between appointment availability and practice access improvements. Results: Of the 58 included primary care practices, 49 (84.5%) completed both the audit and the survey. Overall, 167/536 calls (31.2%) obtained an appointment in 7. days. Practices with PCMH designation were less likely to offer appointments within 7. days (23.4% vs. 33.1%, p = 0.03). However, callers were more likely to obtain an appointment in 7. days from practices offering after-hour appointments (36.3% vs. 27.8%, p = 0.04). After adjusting for insurance type, there were no significant associations between practice improvements and 7-day appointment availability or appointment wait time. Conclusion: PCMH designation and extended-hours appointments were not associated with improved availability of timely primary care follow-up appointment for discharged ED patients. EDs should engage local clinicians and other stakeholders to strengthen linkage and care transition with outpatient practices.

KW - Access to health care

KW - Emergency department

KW - Patient-centered care

UR - http://www.scopus.com/inward/record.url?scp=85041918973&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85041918973&partnerID=8YFLogxK

U2 - 10.1016/j.ajem.2018.01.070

DO - 10.1016/j.ajem.2018.01.070

M3 - Article

JO - American Journal of Emergency Medicine

JF - American Journal of Emergency Medicine

SN - 0735-6757

ER -