Patient centered medical homes did not improve access to timely follow-up after ED visit

Am J Emerg Med. 2018 May;36(5):854-858. doi: 10.1016/j.ajem.2018.01.070. Epub 2018 Feb 4.


Background: Patients newly insured through coverage expansion under the Affordable Care Act (ACA) may have difficulty obtaining timely primary care follow-up appointments after emergency department (ED) discharge. We evaluated the association between availability of timely follow-up appointment with practice access improvements, including patient-centered medical home (PCMH) designations or extended-hours appointments.

Methods: We performed a secret-shopper audit of primary care practices in greater New Haven, Connecticut. Two callers, posing as patients discharged from the ED, called these practices requesting follow-up appointments. They followed standardized scripts varying in ED diagnosis (uncontrolled hypertension, acute back pain) and insurance status (commercial, exchange, Medicaid). We linked our findings with data from a previously completed survey that assessed practice characteristics and examined the associations between appointment availability and practice access improvements.

Results: Of the 58 included primary care practices, 49 (84.5%) completed both the audit and the survey. Overall, 167/536 calls (31.2%) obtained an appointment in 7days. Practices with PCMH designation were less likely to offer appointments within 7days (23.4% vs. 33.1%, p=0.03). However, callers were more likely to obtain an appointment in 7days from practices offering after-hour appointments (36.3% vs. 27.8%, p=0.04). After adjusting for insurance type, there were no significant associations between practice improvements and 7-day appointment availability or appointment wait time.

Conclusion: PCMH designation and extended-hours appointments were not associated with improved availability of timely primary care follow-up appointment for discharged ED patients. EDs should engage local clinicians and other stakeholders to strengthen linkage and care transition with outpatient practices.

Keywords: Access to health care; Emergency department; Patient-centered care.

MeSH terms

  • After-Hours Care / standards
  • After-Hours Care / statistics & numerical data*
  • Aftercare / standards
  • Aftercare / statistics & numerical data*
  • Appointments and Schedules
  • Female
  • Health Services Accessibility / standards
  • Health Services Accessibility / statistics & numerical data*
  • Humans
  • Insurance Coverage / statistics & numerical data
  • Male
  • Medicaid / statistics & numerical data
  • Patient Protection and Affordable Care Act
  • Patient-Centered Care / standards*
  • Patient-Centered Care / statistics & numerical data
  • Surveys and Questionnaires
  • United States