Determinants of loss to follow-up after eye-related emergency visits: A race-stratified analysis at a level I trauma center

by Sinan Ersan, Charles Zhang, Yousef Yousef, Nicholas Kemmis, Brendan Perreault, Ismet F. Vardar, Karen M. Allison, Andrew L. Reynolds, Margaret M. DeAngelis

Importance

Strict adherence to follow-up ophthalmic care after emergency department visits is critical not only for monitoring disease progression, assessing therapeutic response, and preventing avoidable complications, but also because ophthalmic examinations may provide one of the few opportunities to identify otherwise unrecognized systemic disease.

Objective

To identify variables associated with loss to follow-up (LTFU) care after emergency department ophthalmology consultations, and to characterize similarities and differences between self-reported race.

Design

Retrospective cohort study examining emergency department ophthalmology consultations between January 1^st, 2019, and December 31^st, 2021, at a level 1 trauma center serving Western New York, Northern Pennsylvania and Southern Ontario.

Setting

Single center study at Erie County Medical Center in Buffalo, New York, USA.

Participants

A total of 2323 ophthalmology consultations were analyzed.

Main outcomes and measures

The primary outcome was the rate of LTFU, defined as failure to attend a scheduled outpatient appointment. Demographic, diagnostic, and socioeconomic variables were analyzed across all patients and stratified by self-reported racial group (White, African American/Black, and Other). Logistic regression analysis was performed.

Results

Of the 1697/2323 (73.1%) patients that required an outpatient follow-up at The Ira G. Ross Eye Institute, 1003 (59.1%) identified as White, 489 (28.8%) identified as African American/Black and 205 (12.1%) identified as Other. The overall rate of LTFU was 41.8%, with no significant difference in follow-up rates by racial group on multivariable analysis. In the overall patient cohort, LTFU was significantly more common among patients residing in ZIP codes with lower rates of high school completion, those with a longer interval between the emergency department visit and the scheduled follow-up appointment, and those who presented with near-normal visual acuity (close to 20/20). Among White patients, glaucomatous and retinal diagnoses were associated with lower rates of LTFU. Older age, corneal diagnoses and orbital diagnoses were associated with lower rates of LTFU among African American/Black patients.

Conclusions and Relevance

This study identified both shared and distinct factors associated with LTFU across racial groups. These findings provide a foundation for future studies investigating the mechanisms underlying follow-up adherence and may help inform efforts to improve outpatient follow-up.