331 - Factors Linked to Successful Emergency Department Referral to Primary Care for Pediatric Patients without a Primary Care Physician

Publication Number: 331.4989

Sebastian Gualy, Children's Hospital Los Angeles, Los Angeles, CA, United States; Panteha Hayati Rezvan, Children's Hospital Los Angeles, Los Angeles, CA, United States; Tatiana Campuzano, Children's Hospital Los Angeles, Los Angeles, CA, United States; Jeanine E. Hall, Children's Hospital Los Angeles, Los Angeles, CA, United States; Ameer P. Mody, Children's Hospital Los Angeles, Los Angeles, CA, United States; Mia Kanak, Children's Hospital Los Angeles, Los Angeles, CA, United States

Background: Prior studies on post-emergency Department (ED) referrals to care have found limited success, including only approximately half of patients from our tertiary academic center referral program completing a primary care appointment post-referral.

Objective: To identify demographic, operational, and diagnosis-related factors associated with successfully establishing primary care by ED patients without a pediatrician referred to a federally qualified health center (FQHC) network. We hypothesized that appointment completion was more likely associated with younger age, English-speaking status, White race, insurance coverage, ED arrival during business hours, closer proximity to the FQHC clinic site, and lower acuity ED presentations.

Design/Methods: We conducted a retrospective chart review of ED patients without an identified pediatrician referred to an FQHC network between January 2023 to December 2023 via an established electronic referral program. We conducted bivariate analyses to examine demographic and operational differences between patients who completed an appointment within one year of their ED visit and those who did not. Additionally, we reviewed the care provided at the first FQHC visit. Finalized analysis will include additional diagnosis-related variables, and assess associations between appointment completion and potential influencing factors using regression analysis. The institutional review board at Children’s Hospital Los Angeles determined our study to be exempt.

Results: Of 414 ED referrals placed, 139 families of 394 eligible and interested patients were scheduled (35%), of which 106 (26%) families completed an appointment (Figure 1). Those who completed their appointments were more likely to receive an appointment scheduler call sooner (p < 0.001), and required fewer calls to be reached (p < 0.001). Demographic and ED visit characteristics were not found to be significant. Among 106 patients who completed an appointment, 56.6% required referrals to subspecialty care, 40.6% required laboratory studies, and 6.6% required imaging studies.

Conclusion(s): Overall, less than half of pediatric ED patients referred completed a primary care appointment, despite the initial desire to establish PCP care and the high need for specialized care and evaluation exhibited by those who completed an appointment. Contrary to our hypothesis, the only factors found to be associated with appointment completion were modifiable operational factors (e.g. time to initial call and scheduled appointment), which suggests further evaluation of programmatic changes to alleviate barriers to primary care referral are needed.

Figure 1. Flow Diagram for ED
Altamed Referrals Placed to Visits Completed within 1 year for those identified without a pediatrician from January 2023 to December 2023.

Table 1. Demographic, operational, and diagnosis-related characteristics by appointment completion within a year