Factors Influencing Show Rates of Emergency Department Referrals to Primary Care Safety Net Clinics

Utilization of emergency departments for non-urgent conditions has been a longstanding problem leading to excessive health care spending, unnecessary testing, and missed opportunities for patients to form longitudinal relationships with primary care clinicians. The Milwaukee Health Care Partnership established the Emergency Department Care Coordination program to decrease avoidable emergency department visits and connect high-risk individuals with primary care medical homes. Emergency department providers from 8 hospitals schedule patients to safety net clinics to establish follow-up care. During 2018 and 2019, there were 5,035 appointments scheduled, with a 43% show rate. This project aimed to identify factors influencing the show rate to follow-up appointments and to develop program interventions.

This project utilized a database of deidentified patient and referral information and performed logistic regressions to determine factors that influence show rates.

There was a significant difference in show rates when looking at days between the emergency department visit and follow-up appointment, age, receiving clinic, and insurance status (all P > 0.001). Patients seen within 5 days of emergency department visit, patients 65 and older, and uninsured patients had increased likelihood of attending follow-up appointments.

These results demonstrate that older adults are more likely to attend appointments, and more efforts are needed to engage younger people. The analysis shows the need to schedule patients with follow-up primary care quickly, as a short number of days from emergency department visit to primary care appointment was strongly correlated with a higher show rate. In addition, uninsured patients are good candidates for Emergency Department Care Coordination program referrals.