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

CMAJ open Pub Date : 2022-01-01 DOI:10.9778/cmajo.20210132
J. Moe, Elle Yuequiao Wang, M. McGregor, M. Schull, K. Dong, B. Holroyd, C. Hohl, E. Grafstein, F. O’Sullivan, J. Trimble, K. McGrail
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引用次数: 4

Abstract

Background: The population that visits emergency departments frequently is heterogeneous and at high risk for mortality. This study aimed to characterize these patients in Ontario and Alberta, compare them with controls who do not visit emergency departments frequently, and identify subgroups. Methods: This was a retrospective cohort study that captured patients in Ontario or Alberta from fiscal years 2011/12 to 2015/16 in the Dynamic Cohort from the Canadian Institute for Health Information, which defined people with frequent visits to the emergency department in the top 10% of annual visits and randomly selected controls from the bottom 90%. We included patients 18 years of age or older and linked to emergency department, hospitalization, continuing care, home care and mental health–related hospitalization data. We characterized people who made frequent visits to the emergency department over time, compared them with controls and identified subgroups using cluster analysis. We examined emergency department visit acuity using the Canadian Triage and Acuity Scale. Results: The number of patients who made frequent visits to the emergency department ranged from 435 334 to 477 647 each year in Ontario (≥ 4 visits per year), and from 98 840 to 105 047 in Alberta (≥ 5 visits per year). The acuity of these visits increased over time. Those who made frequent visits to the emergency department were older and used more health care services than controls. We identified 4 subgroups of those who made frequent visits: “short duration” (frequent, regularly spaced visits), “older patients” (median ages 69 and 64 years in Ontario and Alberta, respectively; more comorbidities; and more admissions), “young mental health” (median ages 45 and 40 years in Ontario and Alberta, respectively; and common mental health–related and alcohol-related visits) and “injury” (increased prevalence of injury-related visits). Interpretation: From 2011/12 to 2015/16, people who visited emergency departments frequently had increasing visit acuity, had higher health care use than controls, and comprised distinct subgroups. Emergency departments should codevelop interventions with the identified subgroups to address patient needs.
安大略省和阿尔伯塔省频繁急诊科就诊的人群亚组:一项回顾性队列研究
背景:经常去急诊室就诊的人群是异质性的,死亡率很高。这项研究旨在描述安大略省和阿尔伯塔省的这些患者,将他们与不经常去急诊室的对照组进行比较,并确定亚组。方法:这是一项回顾性队列研究,在加拿大卫生信息研究所的动态队列中捕捉了2011/12财政年度至2015/16财政年度安大略省或阿尔伯塔省的患者,该队列将经常去急诊科就诊的人定义为年度就诊的前10%,并从后90%中随机选择对照组。我们纳入了18岁或18岁以上的患者,这些患者与急诊科、住院治疗、持续护理、家庭护理和心理健康相关的住院数据有关。我们对一段时间以来经常去急诊科就诊的人进行了表征,将他们与对照组进行了比较,并使用聚类分析确定了亚组。我们使用加拿大分类和敏锐度量表检查了急诊科就诊的敏锐度。结果:安大略省每年经常去急诊科就诊的患者人数为435 334至477 647人(每年≥4次),阿尔伯塔省每年从98 840至105 047人(每年至少5次)。这些访问的敏锐度随着时间的推移而提高。那些经常去急诊室就诊的人年龄较大,使用的医疗服务比对照组多。我们确定了4个频繁就诊的亚组:“短期”(频繁、定期就诊)、“老年患者”(安大略省和阿尔伯塔省的中位年龄分别为69岁和64岁;合并症更多;入院人数更多),“青少年心理健康”(安大略省和阿尔伯塔省的中位年龄分别为45岁和40岁;以及常见的心理健康相关和酒精相关就诊)和“伤害”(伤害相关就诊的患病率增加)。解释:从2011/12年到2015/16年,经常去急诊科就诊的人就诊的敏锐度越来越高,医疗保健使用率高于对照组,并且包括不同的亚组。急诊科应与确定的亚组共同制定干预措施,以满足患者的需求。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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CiteScore
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