Abstract
Background
Outpatient referrals constitute a critical component of emergency medical care. However,
barriers to care after emergency department (ED) visits have not been investigated
thoroughly.
Objective
The purpose of this study was to determine the impact of sociodemographic variables
on referral attendance after ED visits.
Methods
A 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.
Results
Chart 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).
Conclusions
This 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.
Keywords
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Article info
Publication history
Published online: January 23, 2020
Accepted:
November 10,
2019
Received in revised form:
October 28,
2019
Received:
July 17,
2019
Identification
Copyright
© 2019 Elsevier Inc. All rights reserved.
