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Improving the Use of Early Follow-up Care After Emergency Department Visits: A Randomized Trial

Improving the Use of Early Follow-up Care After Emergency Department Visits: A Randomized Trial Abstract • Objective: To test the hypothesis that the appropriateness of parents' use of early follow-up care after emergency department (ED) visits can be improved by postvisit support from a nurse practitioner. Design: Randomized controlled trial, single blinded. Setting: Urban university hospital ED linked to hospital's primary care center. Participants: Parents of 190 children younger than 8 years who sought care in the ED for acute illnesses and who were treated as outpatients with primary care center follow-up at the discretion of ED clinicians. Intervention: Parents in the experimental group were called by a nurse practitioner who offered both individualized guidance regarding follow-up and access to a nurse practitioner for further help as needed. The control group received "usual" follow-up advice during ED visits. Measurements/Main Results: In the week after the ED visits, parents in the experimental group, compared with parents in the control group, were more compliant with instructions regarding follow-up (79% vs 61 %), less apt to miss appointments (15% vs 31%), and less apt to "shop" elsewhere for care (2% vs 9%). Appropriateness of follow-up was assessed in "blinded" fashion using preestablished guidelines. Inappropriate use of follow-up care was significantly reduced among experimental group subjects (10% vs 20%). Conclusion: The nurse practitioner's intervention improved parents' use of follow-up care in our sample. Overall care for episodic ED users might be improved by similar interventions.(AJDC. 1991;145:440-444) References 1. DeAngelis C, Fosarelli P. Assignment of follow-up appointments from an emergency room by pediatric residents . AJDC . 1985;139:341-342. 2. Fink D, Malloy MJ, Cohen M, Greycloud MA, Martin F. Effective patient care in the pediatric ambulatory setting: a study of the acute care clinic . Pediatrics . 1969;43:927-935. 3. Spivak HR, Levy JC, Bonanno RA, Cracknell M. Patient and provider factors associated with selected measures of quality of care . Pediatrics . 1980;65:307-313. 4. Scherzer LN, Druckman R, Alpert JJ. Care-seeking patterns of families using a municipal hospital emergency room . Med Care . 1980;18:289-296.Crossref 5. Weitzman M, Moomaw MS, Messenger KP. An after-hours pediatric walk-in clinic for an entire urban community: utilization and effectiveness of follow-up care . Pediatrics . 1980;65:964-970. 6. Casey R, Rosen B, Glowasky A, Ludwig S. An intervention to improve follow-up of patients with otitis media . Clin Pediatr. 1985;24:149-152.Crossref 7. Franke RH, Kaul JD. The Hawthorne experiments: first statistical interpretation . Am Sociol Rev. 1978;43:523-643. 8. Pocock SJ, Hughes MD, Lee RJ. Statistical problems in the reporting of clinical trials: a survey of three medical journals . N Engl J Med. 1987;317:426-432.Crossref 9. Jacobsen S. Why is primary care secondary to emergency medicine? Ann Emerg Med. 1986;15:969-970.Crossref 10. Halperin R, Meyers AR, Alpert JJ. Utilization of pediatric emergency services: a critical review . Pediatr Clin North Am . 1979;26:747-757. 11. Starfield B, Simborg DW, Horn SD, Yourtee SA. Continuity and coordination in primary care: their achievement and utility . Med Care . 1976;14:625-636.Crossref 12. Alpert JJ, Robertson LS, Kosa J, Heagarty MC, Haggerty RJ. Delivery of health care for children: report of an experiment . Pediatrics . 1976;57:917-930. 13. O'Shea JS, Collins EW, Pezzullo JC. An attempt to influence health care visits of frequent hospital emergency facility users . Clin Pediatr. 1984;23:559-562.Crossref 14. Straus JH, Orr ST, Charney E. Referrals from an emergency room to primary care practices at an urban hospital . Am J Public Health . 1983;73:57-61.Crossref 15. Horwitz SM. The Impact of Social Stressors and Social Networks on Medical Care Utilization in a Pediatric Population. New Haven, Conn: Yale University; 1984. Unpublished doctoral dissertation. 16. Korsch BM, Gozzi EK, Francis V. Gaps in doctor-patient communication . Pediatrics . 1968;42:855-871. 17. Kahn L, Anderson M, Perkhoff GT. Patients' perceptions and uses of a pediatric emergency room . Soc Sci Med. 1973;7:155-160.Crossref 18. Breslau N. The contribution of pediatric nurse practitioners to child health care . Adv Pediatr. 1982;29:387-405. 19. Fletcher SW, Appel FA, Bourgois M. Improving emergency-room patient follow-up in a metropolitan teaching hospital: effects of a follow-up clerk . N Engl J Med. 1974;291:385-388.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png American Journal of Diseases of Children American Medical Association

Improving the Use of Early Follow-up Care After Emergency Department Visits: A Randomized Trial

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References (20)

Publisher
American Medical Association
Copyright
Copyright © 1991 American Medical Association. All Rights Reserved.
ISSN
0002-922X
DOI
10.1001/archpedi.1991.02160040098016
Publisher site
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Abstract

Abstract • Objective: To test the hypothesis that the appropriateness of parents' use of early follow-up care after emergency department (ED) visits can be improved by postvisit support from a nurse practitioner. Design: Randomized controlled trial, single blinded. Setting: Urban university hospital ED linked to hospital's primary care center. Participants: Parents of 190 children younger than 8 years who sought care in the ED for acute illnesses and who were treated as outpatients with primary care center follow-up at the discretion of ED clinicians. Intervention: Parents in the experimental group were called by a nurse practitioner who offered both individualized guidance regarding follow-up and access to a nurse practitioner for further help as needed. The control group received "usual" follow-up advice during ED visits. Measurements/Main Results: In the week after the ED visits, parents in the experimental group, compared with parents in the control group, were more compliant with instructions regarding follow-up (79% vs 61 %), less apt to miss appointments (15% vs 31%), and less apt to "shop" elsewhere for care (2% vs 9%). Appropriateness of follow-up was assessed in "blinded" fashion using preestablished guidelines. Inappropriate use of follow-up care was significantly reduced among experimental group subjects (10% vs 20%). Conclusion: The nurse practitioner's intervention improved parents' use of follow-up care in our sample. Overall care for episodic ED users might be improved by similar interventions.(AJDC. 1991;145:440-444) References 1. DeAngelis C, Fosarelli P. Assignment of follow-up appointments from an emergency room by pediatric residents . AJDC . 1985;139:341-342. 2. Fink D, Malloy MJ, Cohen M, Greycloud MA, Martin F. Effective patient care in the pediatric ambulatory setting: a study of the acute care clinic . Pediatrics . 1969;43:927-935. 3. Spivak HR, Levy JC, Bonanno RA, Cracknell M. Patient and provider factors associated with selected measures of quality of care . Pediatrics . 1980;65:307-313. 4. Scherzer LN, Druckman R, Alpert JJ. Care-seeking patterns of families using a municipal hospital emergency room . Med Care . 1980;18:289-296.Crossref 5. Weitzman M, Moomaw MS, Messenger KP. An after-hours pediatric walk-in clinic for an entire urban community: utilization and effectiveness of follow-up care . Pediatrics . 1980;65:964-970. 6. Casey R, Rosen B, Glowasky A, Ludwig S. An intervention to improve follow-up of patients with otitis media . Clin Pediatr. 1985;24:149-152.Crossref 7. Franke RH, Kaul JD. The Hawthorne experiments: first statistical interpretation . Am Sociol Rev. 1978;43:523-643. 8. Pocock SJ, Hughes MD, Lee RJ. Statistical problems in the reporting of clinical trials: a survey of three medical journals . N Engl J Med. 1987;317:426-432.Crossref 9. Jacobsen S. Why is primary care secondary to emergency medicine? Ann Emerg Med. 1986;15:969-970.Crossref 10. Halperin R, Meyers AR, Alpert JJ. Utilization of pediatric emergency services: a critical review . Pediatr Clin North Am . 1979;26:747-757. 11. Starfield B, Simborg DW, Horn SD, Yourtee SA. Continuity and coordination in primary care: their achievement and utility . Med Care . 1976;14:625-636.Crossref 12. Alpert JJ, Robertson LS, Kosa J, Heagarty MC, Haggerty RJ. Delivery of health care for children: report of an experiment . Pediatrics . 1976;57:917-930. 13. O'Shea JS, Collins EW, Pezzullo JC. An attempt to influence health care visits of frequent hospital emergency facility users . Clin Pediatr. 1984;23:559-562.Crossref 14. Straus JH, Orr ST, Charney E. Referrals from an emergency room to primary care practices at an urban hospital . Am J Public Health . 1983;73:57-61.Crossref 15. Horwitz SM. The Impact of Social Stressors and Social Networks on Medical Care Utilization in a Pediatric Population. New Haven, Conn: Yale University; 1984. Unpublished doctoral dissertation. 16. Korsch BM, Gozzi EK, Francis V. Gaps in doctor-patient communication . Pediatrics . 1968;42:855-871. 17. Kahn L, Anderson M, Perkhoff GT. Patients' perceptions and uses of a pediatric emergency room . Soc Sci Med. 1973;7:155-160.Crossref 18. Breslau N. The contribution of pediatric nurse practitioners to child health care . Adv Pediatr. 1982;29:387-405. 19. Fletcher SW, Appel FA, Bourgois M. Improving emergency-room patient follow-up in a metropolitan teaching hospital: effects of a follow-up clerk . N Engl J Med. 1974;291:385-388.Crossref

Journal

American Journal of Diseases of Children – American Medical Association

Published: Apr 1, 1991

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