Costs and effects of interventions targeting frequent presenters to the emergency department: a systematic and narrative review

Korczak, Viola; Shanthosh, Janani; Jan, Stephen; Dinh, Michael; Lung, Thomas

doi:10.1186/s12873-019-0296-4

Cited by 26 publications

(38 citation statements)

References 40 publications

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“…5,6 They incur disproportionately high costs because of high ED and other health service use. 7,8 They also make higher acuity visits and are admitted and die more often than non-frequent users. [9][10][11][12][13] Despite the recognized impact of frequent ED use, there is a knowledge gap in how best to address this issue.…”

Section: Introductionmentioning

confidence: 99%

Identifying subgroups and risk among frequent emergency department users in British Columbia

et al. 2021

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Objective: Frequent emergency department (ED) users are heterogeneous. We aimed to identify subgroups and assess their mortality. Methods: We identified patients ≥18 years with ≥1 ED visit in British Columbia from April 1, 2012 to March 31, 2015, and linked to hospitalization, physician billing, prescription, and mortality data. Frequent users were the top 10% of patients by ED visits. We employed cluster analysis to identify frequent user subgroups. We assessed 365day mortality using Kaplan-Meier curves and conducted Cox regressions to assess mortality risk factors within subgroups. Results: We identified 4 subgroups. Subgroup 1 ("Elderly") had median age 77 years (interquartile range [IQR]: 66-85), 5 visits/year (IQR: 4-6), median 8 prescription medications (IQR: 5-11), and 24.7% mortality. Subgroup 2 ("Mental Health and Alcohol Use") had median age 48 years (IQR: 34-61), 13 visits/year (IQR: 10-16), and 12.3% mortality. They made a median 31 general practitioner visits (IQR: 19-51); however, only 23.7% received a majority of services from 1 primary care physician. Subgroup

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Section: Introductionmentioning

confidence: 99%

Identifying subgroups and risk among frequent emergency department users in British Columbia

et al. 2021

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“…5,6 They are high and costly users of other health care services. [7][8][9] In addition, they make higher-acuity visits, and are admitted and die more often than nonfrequent users. [10][11][12][13][14] Effective solutions to improve patient care and decrease costly health care use require a detailed understanding of frequent emergency department users.…”

mentioning

confidence: 99%

Characteristics of frequent emergency department users in British Columbia, Canada: a retrospective analysis

Moe

O’Sullivan

McGregor

et al. 2021

cmajo

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Background: Frequent emergency department users disproportionately account for rising health care costs. We aimed to characterize frequent emergency department users in British Columbia, Canada. Methods: We performed a retrospective analysis using health administrative databases. We included patients aged 18 years or more with at least 1 emergency department visit from 2012/13 to 2015/16, linked to hospital, physician billing, prescription and mortality data. We used annual emergency department visits made by the top 10% of patients to define frequent users (≥ 3 visits/year). Results: Over the study period, 13.8%-15.3% of patients seen in emergency departments were frequent users. We identified 205 136 frequent users among 1 196 353 emergency department visitors. Frequent users made 40.3% of total visits in 2015/16. From 2012/13 to 2015/16, their visit rates per 100 000 BC population showed a relative increase of 21.8%, versus 13.1% among all emergency department patients. Only 1.8% were frequent users in all study years. Mental illness accounted for 8.2% of visits among those less than 60 years of age, and circulatory or respiratory diagnoses for 13.3% of visits among those aged 60 or more. In 2015/16, frequent users were older and had lower household incomes than nonfrequent users; the sex distribution was similar. Frequent users had more prescriptions (median 9, interquartile range [IQR] 5-14 v. 1, IQR 1-3), primary care visits (median 15, IQR 9-27 v. 7, IQR 4-12) and hospital admissions (median 2, IQR 1-3 v. 1, IQR 1-1), and higher 1-year mortality (10.2% v. 3.5%) than nonfrequent users. Interpretation: Emergency department use by frequent users increased in BC between 2012/13 and 2015/16; these patients were heterogenous, had high mortality and rarely remained frequent users over multiple years. Our results suggest that interventions must account for heterogeneity and address triggers of frequent use episodes.

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“…The phenomenon of frequent ED attendance is also an international concern (Althaus et al, 2011;Doupe et al, 2012;Jacob et al, 2016;Krieg et al, 2016;Markham & Graudins, 2011;Van Tiel et al, 2015). Based on ED targets around costs, care provision, patient flow and ED crowding, this group are often the target of ED process interventions (Korczak et al, 2019).…”

Section: Background To the Exemplar Studymentioning

confidence: 99%

Illustrating a novel methodology and paradigm applied to Emergency Department research

Binnie

Brocque

Jessup

et al. 2021

Journal of Advanced Nursing

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Aim: To provide a practical example of how a novel methodology and paradigm was applied to a mixed methods study exploring the healthcare experiences of Australian adults who frequently use emergency department services. Design: Discussion Paper. Data sources: We explored published literature discussing philosophical and methodological issues related to mixed methods research. Literature searches were performed between July 2019 and February 2021. Implications for nursing: Phenomenology is a powerful methodology to explore the lived experience of research participants, but it is not without limitations. Mixed methods phenomenology allows nurse researchers to bring further clarity to their research phenomena, however, including phenomenology in mixed methods studies may be seen to be philosophically incompatible. The philosophical metaparadigm of dialectical pluralism provides nurse researchers with a new coherent methodological and philosophical framework for combining participants' descriptions of lived experience with a variety of data collection methods. It is effective when working with transdisciplinary research teams, and stakeholders representing diverse values and disciplines. Conclusion: Complex healthcare environments require sophisticated, flexible research approaches. This paper presents mixed methods phenomenological research combined with the metaparadigm of dialectical pluralism providing a methodological framework that can support multifaceted nursing research. Impact:The combination of mixed methods phenomenology and dialectical pluralism represents a novel solution for nurse researchers to articulate a research methodology and philosophical paradigm reflecting the complexity embedded in everyday nursing practice. This methodology offers a unique approach to exploration of challenging clinical and patient scenarios with multifaceted elements, and overcomes theories of philosophical incompatibilities between divergent methods.

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Costs and effects of interventions targeting frequent presenters to the emergency department: a systematic and narrative review

Cited by 26 publications

References 40 publications

Identifying subgroups and risk among frequent emergency department users in British Columbia

Identifying subgroups and risk among frequent emergency department users in British Columbia

Characteristics of frequent emergency department users in British Columbia, Canada: a retrospective analysis

Illustrating a novel methodology and paradigm applied to Emergency Department research

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