Anqi Chen1, Maria Ospina2,3, Andrew McRae4,5, Patrick McLane6,7, X Joan Hu8, Scott Fielding6, Rhonda J Rosychuk9,10,11. 1. Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, 524 Edmonton Clinic Health Academy, Edmonton, AB, T6G 1C9, Canada. 2. Department of Obstetrics and Gynecology, University of Alberta, Edmonton, AB, Canada. 3. School of Public Health, University of Alberta, Edmonton, AB, Canada. 4. Department of Emergency Medicine, University of Calgary, Calgary, AB, Canada. 5. Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada. 6. Emergency Strategic Clinical Network, Alberta Health Services, Edmonton, AB, Canada. 7. Department of Emergency Medicine, University of Alberta, Edmonton, AB, Canada. 8. Department of Statistics and Actuarial Science, Simon Fraser University, Burnaby, BC, Canada. 9. Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, 524 Edmonton Clinic Health Academy, Edmonton, AB, T6G 1C9, Canada. rhonda.rosychuk@ualberta.ca. 10. Department of Statistics and Actuarial Science, Simon Fraser University, Burnaby, BC, Canada. rhonda.rosychuk@ualberta.ca. 11. Department of Mathematical and Statistical Sciences, University of Alberta, Edmonton, AB, Canada. rhonda.rosychuk@ualberta.ca.
Abstract
OBJECTIVE: Frequent users to emergency departments (EDs) are a diverse group of patients accounting for a disproportionate number of ED presentations. This study examined sociodemographic and ED visit characteristics of adult high-system users in two Canadian provinces. METHODS: Cohorts of high-system users were created for Alberta and Ontario including patients with the top 10% of presentations in the National Ambulatory Care Reporting System (April 2015-March 2016). Controls were random samples of non-high-system user patients. Sociodemographic and ED visits data were used to predict high-system user group membership in a multivariable logistic regression model. RESULTS: There were 579,674 high-system users and 2,115,960 controls. High-system users were more likely to be female [odds ratio (OR) = 1.1, 95% confidence interval (CI) 1.1,1.1], older (OR 1.02 per 5 years, 95% CI 1.02,1.02), from the lowest-income quintile (OR 1.8, 95% CI 1.7,1.8), and more rural (OR 1.6, 95% CI 1.6,1.6) than controls. High-system users had a higher proportion of presentations by ambulance (OR 1.1 per 0.25 increase, 95% CI 1.1,1.1) and disposition was admission/transfer (OR 1.1 per 0.25 increase, 95% CI 1.1,1.1), left without being seen (OR 1.1, 95% CI 1.1,1.1), or left against medical advice (OR 1.1, 95% CI 1.1,1.1) more often than controls. CONCLUSION: High-system users were more likely to be female, older, live in rural areas and within the lowest-income quintile compared to controls. Their heterogeneity in acuity, comorbid chronic diseases, and limited access to primary care suggests that interventions referring high-system users to primary care may be fruitful in reducing ED utilization by high-system users.
OBJECTIVE: Frequent users to emergency departments (EDs) are a diverse group of patients accounting for a disproportionate number of ED presentations. This study examined sociodemographic and ED visit characteristics of adult high-system users in two Canadian provinces. METHODS: Cohorts of high-system users were created for Alberta and Ontario including patients with the top 10% of presentations in the National Ambulatory Care Reporting System (April 2015-March 2016). Controls were random samples of non-high-system user patients. Sociodemographic and ED visits data were used to predict high-system user group membership in a multivariable logistic regression model. RESULTS: There were 579,674 high-system users and 2,115,960 controls. High-system users were more likely to be female [odds ratio (OR) = 1.1, 95% confidence interval (CI) 1.1,1.1], older (OR 1.02 per 5 years, 95% CI 1.02,1.02), from the lowest-income quintile (OR 1.8, 95% CI 1.7,1.8), and more rural (OR 1.6, 95% CI 1.6,1.6) than controls. High-system users had a higher proportion of presentations by ambulance (OR 1.1 per 0.25 increase, 95% CI 1.1,1.1) and disposition was admission/transfer (OR 1.1 per 0.25 increase, 95% CI 1.1,1.1), left without being seen (OR 1.1, 95% CI 1.1,1.1), or left against medical advice (OR 1.1, 95% CI 1.1,1.1) more often than controls. CONCLUSION: High-system users were more likely to be female, older, live in rural areas and within the lowest-income quintile compared to controls. Their heterogeneity in acuity, comorbid chronic diseases, and limited access to primary care suggests that interventions referring high-system users to primary care may be fruitful in reducing ED utilization by high-system users.
Entities:
Keywords:
Emergency department; Frequent health service users