Funded Projects

PCP Follow-up from the Pediatric ED

Project Year

2025

City & State

Worcester, Massachusetts

Program Name

CATCH Resident

Topic

Access/Barriers to Health Care (LHI)

Program Description

Problem In the UMass Memorial Pediatric Emergency Department (ED), pediatric patients often have no primary care physician (PCP) assigned, leading to inconsistent follow-up for acute medical issues and increased future utilization of emergency services. One group that may present without a PCP are those who are new arrivals to Worcester as members of an immigrant or refugee family. These families face multiple challenges accessing healthcare including language barriers, cultural differences, lack of familiarity with a new healthcare system, and no healthcare insurance or under-insurance. These gaps lead to challenges in establishing care with a PCP and subsequent over-utilization of the ED. Increased utilization of the ED leads to longer wait times and overcrowding, which is shown to create an environment that increases risk for medical errors and adversely affects patient safety (1). In contrast, continuity of care with a PCP leads to increased preventative care, adherence to medications, and recognition of emotional and behavioral issues, through the creation of a relationship that encourages communication and establishes trust (2). New arrival families and other families presenting to the ED without an identified PCP would benefit greatly from connection to acute follow-up as well as long term care.  Primary Setting The primary setting will be the UMass Memorial Pediatric ED in Worcester, Massachusetts, with follow-up occurring in local PCP offices. Our community partners are also located in Worcester, Massachusetts.  Number of Children Affected The exact number of immigrant children in Worcester is not readily accessible, however, according to the annual report by the Massachusetts Office for Refugees and Immigrants (ORI) in 2021 there were 1018 new arrivals to Massachusetts, of which 404 were referred to PCPs via the ORI’s Refugee Health Promotion Program. The number of children presenting to the UMass Memorial Pediatric ED without an identified PCP will be further clarified during the project.  Goal The goal of this project is to understand the barriers to accessing primary care for pediatric patients who present to the ED without an assigned PCP. A subsequent goal of the project will be to use the information gathered to develop an intervention that leverages community resources to best connect pediatric patients with a PCP upon ED discharge.  Proposed Intervention  This project will be conducted using quality improvement methodology. It will complete PDSA cycles by investigating the barriers faced by families in the pediatric ED in obtaining follow-up, and propose interventions to address these barriers. The first step will be to call families who have presented to the ED with their child without an identified PCP to hear about their experience with obtaining a follow-up appointment. We will identify the rate of establishing care with a PCP as a result of ED follow-up. We will simultaneously collaborate with community partners to better understand existing resources and ongoing projects aimed at increasing access to healthcare for immigrants. Based on the information learned from families, we will develop an intervention to increase utilization of these resources to address barriers to connecting patients to primary care. While the final formulation of the intervention will be guided by conversations with the families affected, anticipated interventions include a document of resources or Epic referral system. We will continue calling families to study the effect of the intervention.  Anticipated Outcomes This project will lead to increased follow-up with newly identified PCPs after ED visits, as determined by the number of patients who establish care with a PCP after presenting to the ED before and after initiating an intervention. We will additionally compare the number of patients presenting to the ED without an identified PCP per month before and after initiating the intervention.

Project Goal

The goal of this project is to connect patients with a PCP and improve rates of scheduled follow up appointments within 1 week after Pediatric ED visits.

Project Objective 1

By contacting 20 parents/guardians per month for 6 months of pediatric patients who have presented to the UMass Memorial Pediatric ED without a PCP identified in Epic, we will determine the proportion of these patients who were able to obtain a follow up appointment within one week and identify the barriers that came up when trying to make a follow up appointment.

Project Objective 2

Using the information on barriers to receiving follow up care, as provided by families during the first 6 months of phone calls, we will develop an intervention, such as a handout of local practices organized by insurance accepted or education to providers on making referrals through Epic, to increase the follow up rate with PCPs.

Project Objective 3

After implementing the intervention, we will determine the proportion of patients who obtain follow up appointments with a PCP within one week after an ED visit by contacting 20 parent/guardians per month for an additional 6 months after the intervention is in place.

AAP District

District I

Institutional Name

UMass Memorial Medical Center

Contact 1

Emily Roop, MD