Abstract
Purpose :
Follow-up appointments ensuing emergency visits are critical to providing high-quality care for patients. We performed a retrospective cohort study in a level 1 trauma center to identify variables associated with loss to follow-up (LTFU) after emergency department (ED) ophthalmology consultations. This center serves as the primary safety-net hospital in Western New York, providing for many of the uninsured and underinsured population.
Methods :
ED ophthalmology consultations between 2019 and 2021 at Erie County Medical Center were reviewed. Patient data was collected, and socioeconomic variables were estimated using patient ZIP code data according to the American Census Bureau. Summary statistics were generated using t- and Chi-squared tests. Multivariate logistic regression was applied. P values <0.05 were statistically significant.
Results :
2316 ophthalmology consultations were evaluated. 1695 patients (73.2%) were scheduled for follow-up; 987 (58.2%) attended their follow-up visit. Overall, those who were LTFU were younger (44.7 vs 48.9, p<0.001), male (61% vs 55%, p=0.016), had increased time to follow-up appointment (10.5 vs 6.6 days, p<0.001), better visual acuity (20/56 vs 20/107, p<0.001), lower rates of high school education (86.4% vs 88.2%, p<0.001), lower median incomes ($43,135 vs $46,518, p<0.001), and a higher likelihood of living below the poverty line (21.7% vs 19.1%, p<0.001). The African American/black patients were younger (42.8 vs 47.2, p<0.001), native English speakers (100% vs 96.6%, p<0.001), with lower rates of high school education (83.8% vs 87.5%, p<0.001), lower median incomes ($33,114 vs $45,107, p<0.001), greater rates of Medicaid (23.7% vs 16.4%, p<0.001) and higher proportions below the poverty line (29.7% vs 20.2%, p<0.001). Multivariate logistic regression found, independent of race, that older age, worse visual acuity, high school education, corneal and uveitic diagnoses were all associated with increased follow-up rates. Increased time between the ED visit and scheduled follow-up was associated with LTFU.
Conclusions :
While our findings support that many risk factors are associated with LTFU, we demonstrate that socioeconomic factors including education level are independent risk factors. The African American/black population was found to have lower rates of high school education and income levels, and are therefore likely more vulnerable to LTFU.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.