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

Study Overview
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Brief Summary
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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.

Detailed Description
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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.

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

Conditions
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Conditions Influencing Health Status

Intervention / Treatment
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* Behavioral: ZocDoc Assistance
* Behavioral: ZocDoc Information


Participation Criteria
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Eligibility Criteria
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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). - 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). -

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 100 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

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


Arms and Interventions

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

What is the study measuring?
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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 |