Assessing connection to outpatient care among patients screening positive for previously undiagnosed diabetes in the emergency department: a combined retrospective cohort and prospective cohort survey study

Patients with frequent emergency department (ED) use often have poor connection to primary care, limiting access to preventive screening. Screening patients at risk for diabetes is essential to ensure early treatment via medication and lifestyle changes. While ED screening programs have shown success in diagnosing diabetes, it is unknown the impact on follow-up with subsequent care, and thus downstream patient outcomes. This study aimed to evaluate the efficacy of an emergency department (ED)-based diabetes screening program, assessing follow-up for subsequent management, if patients changed health behaviors or initiated medications, and barriers reported to follow-up if patients did not establish care.

Screening results and patient data from four ED sites of a health system were retrospectively collected; we then performed a phone-based survey of all patients diagnosed with diabetes via ED screening over one year. Patients were queried about diagnosis awareness, connection to follow-up or barriers to establishing care, and health behavior changes (diet, exercise, medications).

Of 9,897 screened ED patients, 615 (6.2%) had diabetes. We surveyed 307 patients (50% response rate). Among newly diagnosed patients; 79% reported obtaining outpatient care, but only 46% recalled ED diagnosis. Health behavior changes included 65% reporting diet improvement, 35% increasing exercise, and 52% starting diabetes medication. Patients who failed to follow-up reported barriers including awareness of screening result, time/scheduling issues, and financial considerations.

This study assesses the reported rate of outpatient care following diabetes diagnosis via an ED screening program and identifies barriers experienced by patients who did not obtain follow-up. Improved connections between screening programs and subsequent care are needed to improve outcomes.