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Brief ReportBrief Report

The Golden Letter: Innovation Collaboration to Reduce Avoidable Hospital Admissions

Mruga Nanavati, Stephen Saenz, Kiersten Swayne and Peter Carek
The Journal of the American Board of Family Medicine November 2020, 33 (6) 1011-1015; DOI: https://doi.org/10.3122/jabfm.2020.06.200077
Mruga Nanavati
the Department of Community Health and Family Medicine, University of Florida, Gainesville, FL (MN, SS, KS, PC).
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Stephen Saenz
the Department of Community Health and Family Medicine, University of Florida, Gainesville, FL (MN, SS, KS, PC).
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Kiersten Swayne
the Department of Community Health and Family Medicine, University of Florida, Gainesville, FL (MN, SS, KS, PC).
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Peter Carek
the Department of Community Health and Family Medicine, University of Florida, Gainesville, FL (MN, SS, KS, PC).
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    Figure 1.

    Template of a Golden Letter.

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    Figure 2.

    Total Golden Letters created and outcomes; ED, emergency department.

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    Table 1.

    Characteristics of Patients Given a Golden Letter in the Emergency Department

    N (%)
    Total191
    Demographics
     Female115 (60.2%)
     Male76 (39.8%)
     65 years or older53 (27.7%)
    Insurance
     Medicaid57 (29.8%)
     Medicare13 (6.8%)
     Commercial22 (11.5%)
     BlueCross81 (42.4%)
     Federal2 (1.0%)
     CMS5 (2.6%)
     Managed care11 (5.8%)
    Follow-up office visit104 (54.5%)
    ED visit within 30 days65 (34.0%)
     Completed follow-up33 (31.7%)
     Did not complete32 (36.8%)
    Inpatient admit within 30 days35 (18.3%)
     Completed follow-up12 (11.5%)
     Did not complete23 (26.4%)
    • CMS, centers for medicare & medicaid; ED, emergency department.

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    Table 2.

    Factors Associated with Attending Follow-up

    Odds Ratio (95% CI)
    Admitted022 (0.08, 0.58)
    ED visit1.74 (0.78, 3.89)
    Over 65 years1.97 (0.92, 4.25)
    Female1.04 (0.56, 1.92)
    Medicare0.27 (0.06, 1.23)
    Medicaid0.44 (0.18, 1.04)
    • ED, emergency department; CI, confidence interval.

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The Journal of the American Board of Family     Medicine: 33 (6)
The Journal of the American Board of Family Medicine
Vol. 33, Issue 6
November-December 2020
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The Golden Letter: Innovation Collaboration to Reduce Avoidable Hospital Admissions
Mruga Nanavati, Stephen Saenz, Kiersten Swayne, Peter Carek
The Journal of the American Board of Family Medicine Nov 2020, 33 (6) 1011-1015; DOI: 10.3122/jabfm.2020.06.200077

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The Golden Letter: Innovation Collaboration to Reduce Avoidable Hospital Admissions
Mruga Nanavati, Stephen Saenz, Kiersten Swayne, Peter Carek
The Journal of the American Board of Family Medicine Nov 2020, 33 (6) 1011-1015; DOI: 10.3122/jabfm.2020.06.200077
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