230 - Evaluation of a Novel Referral Program from a Children’s Hospital Emergency Department to Primary Care: Does Referral Lead to Improved Care?

Poster Number: 230
Publication Number: 230.1682

Background: Interventions to connect pediatric Emergency Department (ED) patients to primary care are needed to improve preventive care access and reduce ED overcrowding.

Objective: To evaluate the effect of a novel ED to federally qualified health center (FQHC) network primary care referral program on preventative care and hospital utilization.

Design/Methods: We conducted a retrospective chart review of patients referred between January 2020 (program inception) and June 2022. The program consisted of ED clinicians placing a newly created electronic medical record referral order for patients without a pediatrician or those requesting a new pediatrician. The order triggered our partnered FQHC to contact the family to schedule an appointment. Families were offered a free parking pass as an incentive to complete appointments. We evaluated program success through process metrics (i.e. numbers referred and time to appointment), and for the first 500 referred patients, outcome measures (i.e. primary care visit metrics and change in post-referral ED visits and hospitalizations).

Results: Overall, >1700 referrals were ordered, 576 appointments were scheduled, and 372 patients completed an appointment within 30 days. Among the first 500 patients referred, 52.8% (210 of 397 that met referral eligibility) were scheduled for and 47.3% (188) completed an appointment. All patients referred, regardless of appointment completion, were similar in age, sex, ethnicity, language, appointment location, and referral reason (Table 1). Those who completed their appointments were significantly more likely to have received a free parking pass compared to those who did not (50.5% vs. 19.1%, p< 0.001).
Patients who completed an appointment were found to have immunization delays, abnormal hemoglobin or lead levels, food insecurity, and require social work referrals (Table 2).
Among patients who completed an appointment, there was no significant change in the average number of ED visits or low acuity ED visits. (Table 3). However, the average number of admissions appeared to increase slightly in the six months following the referral compared to the six months prior (0.064, 95%CI (0.023, 0.105), p=0.0025).

Conclusion(s): Overall, while only about half of pediatric ED patients referred to a medical home successfully completed an appointment, those who did were found to have a significant need for preventive services including vaccinations, screening, and social resources. Given the significant drop-off in patients between referral and appointment completion, further studies to evaluate barriers to connect patients to primary care are needed.