Point-of-Care Follow-Up With Primary Care After Emergency Department Discharge

The purpose of this trial is to determine whether setting up a follow-up appointment for patients who received treatment and were discharged from the emergency department increases their compliance with the follow-up appointment. We are enrolling patients who need a follow-up visit, have health insurance but report do not have a primary care doctor. Patients are randomized to one of three treatment groups: (1) assistance setting up a follow-up appointment by a research assistant using ZocDoc; (2) ZocDoc information given to the subject to set up follow-up appointment by him/herself; or (3) usual discharge instructions by ED staff. Subjects are phoned approximately 2 weeks after the ED visit and asked whether they completed a follow-up visit, satisfaction with their ED visit, satisfaction with their follow-up visit, and additional ED treatment and recovery.

Study Overview

• Status: Completed
• Conditions: Conditions Influencing Health Status
• Intervention / Treatment: Behavioral: ZocDoc Assistance; Behavioral: ZocDoc Information

Detailed Description

This is a randomized controlled trial involving adult emergency department (ED) patients who need a follow-up visit as defined by the ED provider (importance of follow-up rated as 5 or greater on a 0 to 10 scale). There is software available called ZocDoc that provides a user the ability to identify primary care providers who have open appointments and will take the person's health insurance (in network and outside of network) and list the doctors based on their proximity to the person in need. We are testing whether booking appointments for ED patients using ZocDoc vs. giving patients the information to use ZocDoc themselves vs. standard discharge instructions given by ED staff (i.e. you should follow-up with a primary care doctor) affects compliance with self-reported follow-up visits. We are enrolling patients while they are in the ED, completed a short baseline interview and then another interview with them over the telephone approximately two weeks after the index ED visit. The follow-up interview asks subjects whether they have completed a follow-up visit, satisfaction with the ED visit and the primary care visit, any other additional ED treatment and extent of recovery from the problem that brought them to the ED the first time.

• Study Type: Interventional
• Enrollment (Actual): 220
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • District of Columbia
    • Washington, D.C., District of Columbia, United States, 20037
      • George Washington University Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 100 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria: Patients with health insurance but report not having a primary care provider and are rated by the ED provider as needing a follow-up visit with a primary care provider (rated as moderate to high need by ED provider).

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Exclusion Criteria: Patients doesn't want a primary care provider or patient doesn't want a follow-up visit. Patient is unable to understand consent, is a prisoner, or does not have access to email (because ZocDoc sends appointment information to email).

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Study Plan

How is the study designed?

Design Details

• Primary Purpose: Health Services Research
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Double

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: ZocDoc Assistance; Research assistant sets up follow-up appointment for subject using ZocDoc.	Behavioral: ZocDoc Assistance; Research assistant sets up a follow-up appointment for a subject with a primary care doctor using ZocDoc
Active Comparator: ZocDoc Information; Research assistance provides subject with written information about ZocDoc.	Behavioral: ZocDoc Information; Providing ZocDoc information to subjects so that they can make a follow-up appointment with a primary care doctor themselves
No Intervention: Usual Care; ED staff gives written and verbal discharge instructions to subject.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Self-reported follow-up visit	patient-reported follow-up visit with a primary care doctor	2-4 weeks after the index ED visit

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Satisfaction with the ED visit	patient-reported satisfaction rating	Measured 2 weeks after the index ED visit
Satisfaction with the primary care visit	patient-reported satisfaction rating	2-4 weeks after the index ED visit
Recovery from health problem	patient-reported resolution of problem that they reported during index ED visit	2-4 weeks after the index ED visit
Additional ED visit(s)	Did patient receive additional ED treatment for same problem as index ED visit	2-4 weeks after the index ED visit

Collaborators and Investigators

• Sponsor: George Washington University
• Investigators: Principal Investigator: Tina Choudri, MD, George Washington University

Publications and helpful links

General Publications

• Doran KM, Colucci AC, Hessler RA, Ngai CK, Williams ND, Wallach AB, Tanner M, Allen MH, Goldfrank LR, Wall SP. An intervention connecting low-acuity emergency department patients with primary care: effect on future primary care linkage. Ann Emerg Med. 2013 Mar;61(3):312-321.e7. doi: 10.1016/j.annemergmed.2012.10.021. Epub 2012 Dec 20.
• Chan TC, Killeen JP, Castillo EM, Vilke GM, Guss DA, Feinberg R, Friedman L. Impact of an internet-based emergency department appointment system to access primary care at safety net community clinics. Ann Emerg Med. 2009 Aug;54(2):279-84. doi: 10.1016/j.annemergmed.2008.10.030. Epub 2008 Dec 13.

Study record dates

Study Major Dates

• Study Start (Actual): November 1, 2015
• Primary Completion (Actual): June 1, 2017
• Study Completion (Actual): July 31, 2017

Study Registration Dates

• First Submitted: April 13, 2016
• First Submitted That Met QC Criteria: April 13, 2016
• First Posted (Estimate): April 15, 2016

Study Record Updates

• Last Update Posted (Actual): August 8, 2017
• Last Update Submitted That Met QC Criteria: August 4, 2017
• Last Verified: August 1, 2017

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Pathologic Processes; Disease Attributes; Emergencies
• Other Study ID Numbers: 091554