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Sociodemographic Factors Associated With Adherence to Referrals From the Pediatric Emergency Department
Benjamin A Palleiko1, Jeremy V Lynn2, Angie H Achkar1
1Office for Health Equity and Inclusion, University of Michigan, Ann Arbor, Michigan.
Insights
Sociodemographic factors significantly impact outpatient referral attendance after pediatric emergency department visits. Disparities in attendance were noted among various patient groups, highlighting a need for targeted interventions to improve follow-up care.
Area of Science:
- Pediatric Emergency Medicine
- Health Services Research
- Health Disparities
Background:
- Outpatient referrals are crucial for continuity of care following emergency department (ED) visits.
- Barriers to post-ED referral attendance remain under-investigated, particularly in pediatric populations.
Purpose of the Study:
- To investigate the influence of sociodemographic variables on referral attendance rates after pediatric emergency department visits.
- To identify patient characteristics associated with missed outpatient appointments following ED care.
Main Methods:
- Retrospective cohort study of pediatric patients (0-17 years) with referrals from a children's hospital ED in 2016.
- Analysis of 6120 ED encounters and 822 outpatient referrals, counting multiple referrals per patient as distinct events.
Main Results:
- Referral attendance varied significantly by sociodemographic factors, including age, race, insurance status, and socioeconomic indicators of the patient's residence.
- Black females, patients with public insurance, and those from areas with high unemployment or low educational attainment showed decreased attendance.
- Attendance rates differed by specialty, with lower attendance for neurology referrals and higher attendance for orthopedic surgery referrals.
Conclusions:
- Significant disparities in outpatient referral attendance exist after pediatric emergency care.
- Sociodemographic and departmental factors play a role in missed follow-up appointments.
- Targeted resource allocation is needed to address these disparities and improve care for vulnerable pediatric populations.
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.
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