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Cecilia Qianwen Dong, Bilal Farhat, Jonathan Nicholas Kruh; Patterns of follow up after emergency room ophthalmic consultation. Invest. Ophthalmol. Vis. Sci. 2018;59(9):5251.
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To identify risk factors unique to ophthalmology that predict subsequent follow-up in patients evaluated by the ophthalmology service in the emergency department (ED) at Jamaica Hospital Medical Center, a level I trauma center in Queens, New York. To use gathered data to develop a quality improvement initiative to increase attrition rate.
This is a retrospective chart review of ophthalmology consultations in the ED from 1/2013 to 6/2016. We included adult patients of New York State who were recommended follow-up care. In total, 1242 patients were reviewed and 661 included in the study. Covariates studied were: basic demographics, previous relationship with the hospital, visual acuity, presence of visual disturbance, and diagnosis. Diagnosis was further categorized into trauma or non-trauma, and graded on a severity scale assigned by experienced ophthalmologists. Primary outcome was whether the patient followed up as instructed. Regression, one-way ANOVA, and Chi-square tests were used to determine association between covariates and outcome.
Of 661 patients, follow-up rate was 43.2% after initial ED visit. Those with self-limiting conditions had the lowest follow-up rate at 30.9%; whereas those with vision-threatening conditions had the highest rate at 67.6% (p<0.001). Each unit decrease in LogMAR visual acuity was associated with a 1.26-fold increase in odds of follow-up (1.03-1.58, p=0.034). Furthermore, self-reported visual disturbance was associated with a 1.64-fold increase in follow-up compared to those without any change in vision. Patients with traumatic eye injury were 1.50 times more likely than non-trauma patients to be lost to follow-up (1.10-2.05). Having insurance was associated with 1.73 x increase in odds of follow-up (1.19-2.52, p=0.004). Factors that did not independently affect follow-up: age, gender, race, employment status, type of insurance, and previously relationship with the hospital. A small group (n=11) who received a phone-call after the ED visit showed improved follow-up rate of 63.6%.
In this population, the majority of patients with an eye emergency did not follow up. Factors correlating with poor follow up, in order of strongest association, were lack of insurance, lack of visual disturbance, presence of trauma, and better visual acuity. Future directions are aimed at implementing changes to protocol to minimize barriers to follow up and improve compliance.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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