Factors Linked to Successful Emergency Department Referral to Primary Care for Pediatric Patients without a Primary Provider.

INTRODUCTION: Prior studies on post-emergency Department (ED) referrals to primary care have found limited success. This study identifies factors associated with establishing primary care for pediatric ED patients without a pediatrician referred to a federally qualified health center (FQHC) network. METHODS: We conducted a retrospective review of ED patients without a pediatrician referred to an FQHC network in 2023 via an established electronic referral program, examining demographic, operational, and clinical differences between patients who completed appointments within one year of their ED Index visit and those who did not. Types of care provided at the first FQHC visit were examined. RESULTS: Of 414 referrals, 140 families scheduled appointments (35.5%) and 106 (75.7% of scheduled) completed appointments within one year. In unadjusted analyses, patients who completed appointments received scheduler calls sooner (median 2 vs. 3 days; p < 0.001) and required fewer contact attempts (median 1 vs. 2; p = 0.002). Respiratory and neurologic diagnoses were associated with higher scheduling and completion rates (p < 0.05). After adjustment, shorter time to scheduler contact and fewer contact attempts remained associated with completion (both p < 0.001). Among completers, 56.6% received subspecialty referrals, 40.6% had labs ordered, and 6.6% had imaging ordered at their first visit. DISCUSSION: Around one-quarter of referred pediatric ED patients completed FQHC appointments despite expressed interest and need for ongoing care. Only modifiable operational factors, specifically timing of outreach and scheduling, were associated with appointment completion, suggesting primary care access may be improved by programmatic improvements in these areas.