206-OR: Assessing Connection to Outpatient Care among Patients Screening Positive for Previously Undiagnosed Diabetes in the Emergency Department

Introduction & Objective: Patients with frequent emergency department (ED) use often have poor connection to primary care, which limits their access to the preventive screening necessary to diagnose diabetes early. Our objective was to assess how frequently patients connected with outpatient care after a new diagnosis of diabetes through an ED-based screening program.

Methods: We performed a survey of all ED patients with newly diagnosed diabetes in 2022 at our health system, which now screens all ED patients aged 35 to 70 years old with a BMI ≥ 25 that do not have a prior history of diabetes in our records. HbA1c tests are added among those already receiving blood work as part of their care. We contacted each of these patients at least 6 months after they had been screened to participate in a phone-based survey about awareness of their new diagnosis, follow-up for outpatient care, and changes in health behaviors.

Results: In 2022, we screened 9,897 ED patients and found that 615 (6.2%) had a HbA1c ≥ 6.5%. After 3 rounds of phone calls, we successfully surveyed 307 for a response rate of 50%. We found that 44% of these patients had a pre-existing history of diabetes not reflected in our health records when they were screened. Analyzing the 171 ED patients with newly diagnosed with diabetes that were successfully surveyed, we found that 79% met with an outpatient provider after screening positive for diabetes, however, only 46% remembered being diagnosed. Of those with a new diagnosis, 65% reported improving their diet, 35% reported exercising more, and 52% reported starting medications for diabetes.

Conclusion: Connection to outpatient care after a new diagnosis of diabetes in the ED was more robust than anticipated, at least among those successfully surveyed. However, we identified key gaps: many patients did not remember their diagnosis, some reported barriers to outpatient care, and several patients were not started any medications despite a high HbA1c.