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

Shih Chuan Chou, Craig Rothenberg, Alicia Agnoli, Ilse Wiechers, Jason Lott, Jennifer Voorhees, Steven L. Bernstein, Arjun K. Venkatesh

Research output: Contribution to journalArticlepeer-review


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 7 days. Practices with PCMH designation were less likely to offer appointments within 7 days (23.4% vs. 33.1%, p = 0.03). However, callers were more likely to obtain an appointment in 7 days 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.

Original languageEnglish
Pages (from-to)854-858
Number of pages5
JournalAmerican Journal of Emergency Medicine
Issue number5
Early online date4 Feb 2018
Publication statusPublished - May 2018


  • Access to health care
  • Emergency department
  • Patient-centered care


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