Ambulatory Care Follow-Up and Fragmentation After Emergency Department Visits Among Older Adults

ObjectivesThis study aimed to characterize ambulatory care patterns among older adults discharged from the emergency department (ED).MethodsThis retrospective cohort study of 55,391 ED visits from the 2015-2021 Medicare Current Beneficiary Survey examined ambulatory follow-up within 7 and 30 days. Care fragmentation was assessed by identifying visits where patients saw 2+ different providers. Zero-inflated negative binomial models analyzed associations between patient characteristics (e.g., dementia, multiple chronic conditions) and follow-up.ResultsFollow-up occurred in 22.9% and 44.2% of cases within 7 and 30 days, respectively. Care fragmentation occurred in 4.6% and 25.3% of cases. Dementia reduced follow-up odds (OR 0.74; 95% CI 0.66-0.84; p < 0.001), while multiple chronic conditions increased them (OR 1.27; 95% CI 1.19-1.36; p < 0.001).DiscussionMost older adults lack timely ED follow-up, and care can be fragmented. These patterns highlight the need for interventions to balance access and fragmentation while improving outcomes.