Subgroups of people who make frequent emergency department visits in Ontario and Alberta: a retrospective cohort study

Moe, Jessica; Wang, Elle Yuequiao; McGregor, Margaret J.; Schull, Michael J.; Dong, Kathryn; Holroyd, Brian R.; Hohl, Corinne M.; Grafstein, Eric; O’Sullivan, Fiona; Trimble, Johanna; McGrail, Kimberlyn

doi:10.9778/cmajo.20210132

Cited by 5 publications

(14 citation statements)

References 38 publications

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“…Our analysis corroborates previous work demonstrating that data-driven cluster analysis can discriminate subgroups of people who visit EDs frequently, which are comparable across Canadian provinces [ 14 , 46 ]. The 6.6% and 9.3% 365-day mortality we identified in “moderate” and “extreme” subgroups in B.C.were comparable to 4.7% to 8.8% mortality reported among people who made alcohol-related ED visits with increasing frequency in Ontario [ 13 ].…”

Section: Discussionsupporting

confidence: 90%

Characterizing people with frequent emergency department visits and substance use: a retrospective cohort study of linked administrative data in Ontario, Alberta, and B.C., Canada

et al. 2022

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Background Substance use is common among people who visit emergency departments (EDs) frequently. We aimed to characterize subgroups within this cohort to better understand care needs/gaps, and generalizability of characteristics in three Canadian provinces. Methods This was a retrospective cohort study (April 1st, 2013 to March 31st, 2016) of ED patients in Ontario, Alberta, and British Columbia (B.C.) We included patients ≥ 18 years with substance use-related healthcare contact during the study period and frequent ED visits, defined as those in the top 10% of ED utilization when all patients were ordered by annual ED visit number. We used linked administrative databases including ED visits and hospitalizations (all provinces); mental heath-related hospitalizations (Ontario and Alberta); and prescriptions, physician services, and mortality (B.C.). We compared to cohorts of people with (1) frequent ED visits and no substance use, and (2) non-frequent ED visits and substance use. We employed cluster analysis to identify subgroups with distinct visit patterns and clinical characteristics during index year, April 1st, 2014 to March 31st, 2015. Results In 2014/15, we identified 19,604, 7,706, and 9,404 people with frequent ED visits and substance use in Ontario, Alberta, and B.C (median 37–43 years; 60.9–63.0% male), whose ED visits and hospitalizations were higher than comparison groups. In all provinces, cluster analyses identified subgroups with “extreme” and “moderate” frequent visits (median 13–19 versus 4–6 visits/year). “Extreme” versus “moderate” subgroups had more hospitalizations, mental health-related ED visits, general practitioner visits but less continuity with one provider, more commonly left against medical advice, and had higher 365-day mortality in B.C. (9.3% versus 6.6%; versus 10.4% among people with frequent ED visits and no substance use, and 4.3% among people with non-frequent ED visits and substance use). The most common ED diagnosis was acute alcohol intoxication in all subgroups. Conclusions Subgroups of people with “extreme” (13–19 visits/year) and “moderate” (4–6 visits/year) frequent ED visits and substance use had similar utilization patterns and characteristics in Ontario, Alberta, and B.C., and the “extreme” subgroup had high mortality. Our findings suggest a need for improved evidence-based substance use disorder management, and strengthened continuity with primary and mental healthcare.

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Section: Discussionsupporting

confidence: 90%

Characterizing people with frequent emergency department visits and substance use: a retrospective cohort study of linked administrative data in Ontario, Alberta, and B.C., Canada

et al. 2022

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“…The increase in the number of hospital emergency department (ED) visits by older people is a worldwide phenomenon [ 13 , 14 , 15 ]. Furthermore, the figures will further grow over the coming years as the older population continues to increase.…”

Section: Discussionmentioning

confidence: 99%

Challenges in the Detection of Clinically Useful Biomarkers for the Diagnosis of Delirium in Older People in the Emergency Department—A Case–Control Study

Soler-Sanchis

Martínez-Arnau

Sánchez-Frutos

et al. 2022

Life

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Background: The identification of biomarkers associated with delirium in the emergency department could contribute to the understanding, prediction and diagnosis of this disorder. The present study was carried out to identify biomarkers included in easily and quickly obtained standard blood examinations in older patients with delirium in the emergency department. Methods: A case–control study was carried out in the emergency department of Francesc de Borja Hospital (Gandía, Valencia, Spain). Older adults (≥65 years of age) diagnosed with delirium (n = 128) were included. Cases due to alcohol or substance abuse were excluded. Controls were selected on a randomized basis from the remaining patients (n = 128). All laboratory test parameters included in the routine blood and urine tests of the emergency department were collected. Results: The mean age of the patients was 81.24 ± 7.51 years, and 56.2% were males, while the mean age of the controls was 78.97 ± 7.99 years, and 45.3% were males. Significant differences were found between the cases and controls in relation to the following parameters: urea 43 (32–58) mg/dL versus 50 (37–66) mg/dL, respectively; neutrophils 69.6 (62.05–78.75)% versus 75.5 (65.1–83.2)%; monocytes 8.7 (7–10.4)% versus 7.6 (5.5–9.2)%; platelets 213 (159–266) × 109/L versus 224 (182–289) × 109/L; neutrophil–lymphocyte ratio 3.88 (2.45–7.07) versus 5 (2.75–8.83); platelet–lymphocyte ratio 281.4 (210–360) versus 357.1 (257.8–457.1); and mean platelet volume 10.6 (10–11.5) fl versus 10.4 (9.67–10.9) fl. Although the mean values were above desirable levels in both groups, they were higher for most parameters in the control group. No significant differences were observed in C-reactive protein concentration (9.99 (1.69–51) mg/L versus 12.3 (3.09–65.97) mg/L). Conclusions: The identification of delirium biomarkers poses difficulties due to the urgent nature of the disorders found in older people admitted to the emergency department. Research in this field is needed, since it would allow early identification and treatment of delirium.

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“…Of these, seven studies found females were higher resource users than males and six found that sex-based differences were dependent upon other factors. Females were identified as higher resource users in multiple health care settings, including health services for all ages [16,17,21,22,28], health services for youth [29,30], primary care for all ages, and adult emergency department presentations [21,31].…”

Section: Sexmentioning

confidence: 99%

“…Three studies used comorbidity scores or indices -ie. the Charlson Comorbidity Index (CCI) -to determine the burden of comorbidities [16,17,21,22,28,32]. Patients with higher scores on the comorbidity indices were more likely to be hospitalized [28] and to see primary care and specialist visits [17].…”

Section: Comorbiditiesmentioning

confidence: 99%

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Characteristics of High-Resource Health System Users in Rural and Remote Regions: A Scoping Review

LeBlanc¹,

McGaughey²,

Peters³

2023

Preprint

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A small proportion of health care users are recognised to use a significantly higher proportion of health system resources, largely due to systemic, inequitable access and disproportionate health burdens. These high-resource health system users are routinely characterised as older, with multiple comorbidities, and reduced access to adequate health care. Geographic trends also emerge, with more rural and isolated regions demonstrating higher rates of high-resource use than others. Despite known geographical discrepancies in health care access and outcomes, health policy and research initiatives remain focused on urban population centers. To alleviate mounting health system pressure from high-resource users, their characteristics must be better understood within the context in which it arises. To examine this, a scoping review was conducted to provide an overview of characteristics of high-resource users in rural and remote communities in Canada and Australia. In total, 21 papers were included in the review. Using qualitative thematic coding, primary findings characterised rural high-resource users as those of an older age; with increased comorbid conditions and condition severity; lower socioeconomic status; and elevated risk behaviours.

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Subgroups of people who make frequent emergency department visits in Ontario and Alberta: a retrospective cohort study

Cited by 5 publications

References 38 publications

Characterizing people with frequent emergency department visits and substance use: a retrospective cohort study of linked administrative data in Ontario, Alberta, and B.C., Canada

Characterizing people with frequent emergency department visits and substance use: a retrospective cohort study of linked administrative data in Ontario, Alberta, and B.C., Canada

Challenges in the Detection of Clinically Useful Biomarkers for the Diagnosis of Delirium in Older People in the Emergency Department—A Case–Control Study

Characteristics of High-Resource Health System Users in Rural and Remote Regions: A Scoping Review

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