1
|
Samosh J, Agha A, Pettey D, Sylvestre J, Aubry T. Community Mental Health Services for Frequent Emergency Department Users: A Qualitative Study of Outcomes Perceived by Program Clients and Case Managers. Prof Case Manag 2024; 29:139-148. [PMID: 38037223 DOI: 10.1097/ncm.0000000000000692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
PURPOSE OF STUDY This study aimed to investigate the perceived outcomes and mechanisms of change of a community mental health service combining system navigation and intensive case management supports for frequent emergency department users presenting with mental illness or addiction. PRIMARY PRACTICE SETTING The study setting was a community mental health agency receiving automated referrals directly from hospitals in a midsize Canadian city for all individuals attending an emergency department two or more times within 30 days for mental illness or addiction. METHODOLOGY AND SAMPLE Qualitative interviews with 15 program clients. Focus groups with six program case managers. Data were analyzed using pragmatic qualitative thematic analysis. RESULTS Participants generally reported perceiving that the program contributed to reduced emergency department use, reduced mental illness symptom severity, and improved quality of life. Perceived outcomes were more mixed for outcomes related to addiction. Reported mechanisms of change emphasized the importance of positive working relationships between program clients and case managers, as well as focused efforts to develop practical skills. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE Community mental health services including intensive case management for frequent emergency department users presenting with mental illness or addiction were perceived to effectively address client needs while reducing emergency department resource burden. Similar programs should emphasize the development of consistent and warm working relationships between program clients and case managers, as well as practical skills development to support client health and well-being.
Collapse
Affiliation(s)
- Jonathan Samosh
- Jonathan Samosh, MSc, is a PhD candidate in Clinical Psychology at the University of Ottawa's School of Psychology and Centre for Research on Educational and Community Services. His research interests include community mental health and homelessness
- Ayda Agha, MScCH, is a PhD candidate in Experimental Psychology at the University of Ottawa's School of Psychology and Centre for Research on Educational and Community Services. Her research interests include community mental health and homelessness
- Donna Pettey, PhD, RSW, is Director of Integration, Research, and Evaluation at the Canadian Mental Health Association's Ottawa Branch. She provides research leadership to the agency to support clinical decision-making in the provision of community mental health services
- John Sylvestre, PhD, is Full Professor at the School of Psychology and Senior Researcher at the Centre for Research on Educational and Community Services at the University of Ottawa. His research interests include community mental health and homelessness
- Tim Aubry, PhD, CPsych, is Full Professor at the School of Psychology and Senior Researcher at the Centre for Research on Educational and Community Services at the University of Ottawa. His research interests include community mental health and homelessness
| | - Ayda Agha
- Jonathan Samosh, MSc, is a PhD candidate in Clinical Psychology at the University of Ottawa's School of Psychology and Centre for Research on Educational and Community Services. His research interests include community mental health and homelessness
- Ayda Agha, MScCH, is a PhD candidate in Experimental Psychology at the University of Ottawa's School of Psychology and Centre for Research on Educational and Community Services. Her research interests include community mental health and homelessness
- Donna Pettey, PhD, RSW, is Director of Integration, Research, and Evaluation at the Canadian Mental Health Association's Ottawa Branch. She provides research leadership to the agency to support clinical decision-making in the provision of community mental health services
- John Sylvestre, PhD, is Full Professor at the School of Psychology and Senior Researcher at the Centre for Research on Educational and Community Services at the University of Ottawa. His research interests include community mental health and homelessness
- Tim Aubry, PhD, CPsych, is Full Professor at the School of Psychology and Senior Researcher at the Centre for Research on Educational and Community Services at the University of Ottawa. His research interests include community mental health and homelessness
| | - Donna Pettey
- Jonathan Samosh, MSc, is a PhD candidate in Clinical Psychology at the University of Ottawa's School of Psychology and Centre for Research on Educational and Community Services. His research interests include community mental health and homelessness
- Ayda Agha, MScCH, is a PhD candidate in Experimental Psychology at the University of Ottawa's School of Psychology and Centre for Research on Educational and Community Services. Her research interests include community mental health and homelessness
- Donna Pettey, PhD, RSW, is Director of Integration, Research, and Evaluation at the Canadian Mental Health Association's Ottawa Branch. She provides research leadership to the agency to support clinical decision-making in the provision of community mental health services
- John Sylvestre, PhD, is Full Professor at the School of Psychology and Senior Researcher at the Centre for Research on Educational and Community Services at the University of Ottawa. His research interests include community mental health and homelessness
- Tim Aubry, PhD, CPsych, is Full Professor at the School of Psychology and Senior Researcher at the Centre for Research on Educational and Community Services at the University of Ottawa. His research interests include community mental health and homelessness
| | - John Sylvestre
- Jonathan Samosh, MSc, is a PhD candidate in Clinical Psychology at the University of Ottawa's School of Psychology and Centre for Research on Educational and Community Services. His research interests include community mental health and homelessness
- Ayda Agha, MScCH, is a PhD candidate in Experimental Psychology at the University of Ottawa's School of Psychology and Centre for Research on Educational and Community Services. Her research interests include community mental health and homelessness
- Donna Pettey, PhD, RSW, is Director of Integration, Research, and Evaluation at the Canadian Mental Health Association's Ottawa Branch. She provides research leadership to the agency to support clinical decision-making in the provision of community mental health services
- John Sylvestre, PhD, is Full Professor at the School of Psychology and Senior Researcher at the Centre for Research on Educational and Community Services at the University of Ottawa. His research interests include community mental health and homelessness
- Tim Aubry, PhD, CPsych, is Full Professor at the School of Psychology and Senior Researcher at the Centre for Research on Educational and Community Services at the University of Ottawa. His research interests include community mental health and homelessness
| | - Tim Aubry
- Jonathan Samosh, MSc, is a PhD candidate in Clinical Psychology at the University of Ottawa's School of Psychology and Centre for Research on Educational and Community Services. His research interests include community mental health and homelessness
- Ayda Agha, MScCH, is a PhD candidate in Experimental Psychology at the University of Ottawa's School of Psychology and Centre for Research on Educational and Community Services. Her research interests include community mental health and homelessness
- Donna Pettey, PhD, RSW, is Director of Integration, Research, and Evaluation at the Canadian Mental Health Association's Ottawa Branch. She provides research leadership to the agency to support clinical decision-making in the provision of community mental health services
- John Sylvestre, PhD, is Full Professor at the School of Psychology and Senior Researcher at the Centre for Research on Educational and Community Services at the University of Ottawa. His research interests include community mental health and homelessness
- Tim Aubry, PhD, CPsych, is Full Professor at the School of Psychology and Senior Researcher at the Centre for Research on Educational and Community Services at the University of Ottawa. His research interests include community mental health and homelessness
| |
Collapse
|
2
|
Liu Y, Manavalan P, Siddiqi K, Cook RL, Prosperi M. Comorbidity Burden and Health Care Utilization by Substance use Disorder Patterns among People with HIV in Florida. AIDS Behav 2024; 28:2286-2295. [PMID: 38551720 PMCID: PMC11199104 DOI: 10.1007/s10461-024-04325-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2024] [Indexed: 05/16/2024]
Abstract
Substance use disorder (SUD), a common comorbidity among people with HIV (PWH), adversely affects HIV clinical outcomes and HIV-related comorbidities. However, less is known about the incidence of different chronic conditions, changes in overall comorbidity burden, and health care utilization by SUD status and patterns among PWH in Florida, an area disproportionately affected by the HIV epidemic. We used electronic health records (EHR) from a large southeastern US consortium, the OneFlorida + clinical research data network. We identified a cohort of PWH with 3 + years of EHRs after the first visit with HIV diagnosis. International Classification of Diseases (ICD) codes were used to identify SUD and comorbidity conditions listed in the Charlson comorbidity index (CCI). A total of 42,271 PWH were included (mean age 44.5, 52% Black, 45% female). The prevalence SUD among PWH was 45.1%. Having a SUD diagnosis among PWH was associated with a higher incidence for most of the conditions listed on the CCI and faster increase in CCI score overtime (rate ratio = 1.45, 95%CI 1.42, 1.49). SUD in PWH was associated with a higher mean number of any care visits (21.7 vs. 14.8) and more frequent emergency department (ED, 3.5 vs. 2.0) and inpatient (8.5 vs. 24.5) visits compared to those without SUD. SUD among PWH was associated with a higher comorbidity burden and more frequent ED and inpatient visits than PWH without a diagnosis of SUD. The high SUD prevalence and comorbidity burden call for improved SUD screening, treatment, and integrated care among PWH.
Collapse
Affiliation(s)
- Yiyang Liu
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, 2004 Mowry Road, PO Box 100231, Gainesville, FL, 32610-0231, USA.
| | - Preeti Manavalan
- Department of Medicine, Division of Infectious Diseases & Global Medicine, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Khairul Siddiqi
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Robert L Cook
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, 2004 Mowry Road, PO Box 100231, Gainesville, FL, 32610-0231, USA
| | - Mattia Prosperi
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, 2004 Mowry Road, PO Box 100231, Gainesville, FL, 32610-0231, USA
| |
Collapse
|
3
|
Shah H, Hawks L, Walker RJ, Egede LE. Substance Use Disorders, Mental Illness, and Health Care Utilization Among Adults With Recent Criminal Legal Involvement. Psychiatr Serv 2024; 75:221-227. [PMID: 37674397 DOI: 10.1176/appi.ps.20220491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Abstract
OBJECTIVE Individuals involved with the criminal legal system have higher rates of mental illness, addiction, and health care utilization. The authors examined whether substance use disorders and mental illness alone or in combination drive health care utilization among those with recent criminal legal involvement. METHODS This cross-sectional analysis used nationally representative data from U.S. adults with past-year criminal legal involvement (N=9,039) recorded in the National Survey on Drug Use and Health (2015-2019). Using adjusted negative binomial regression models, the authors estimated relative risks for health care utilization. Primary independent variable categories included neither substance use disorder nor mental illness, substance use disorder only, mental illness only, and both conditions. Health care utilization included emergency department (ED) visits and nights spent in inpatient care. RESULTS Relative to neither mental illness nor substance use disorder, mental illness alone was associated with significantly increased acute health care services use: for ED visits, incidence risk ratio (IRR)=1.43 (95% CI=1.18-1.75) and for inpatient stays, IRR=2.14 (95% CI=1.47-3.11). Having both conditions was associated with increased ED visits (IRR=1.62, 95% CI=1.38-1.91) and inpatient stays (IRR=4.16, 95% CI=2.98-5.82). Substance use disorder alone was associated only with higher risk for ED visits compared with neither condition (IRR=1.23, 95% CI=1.01-1.50). CONCLUSIONS Mental illness with or without co-occurring substance use disorder is a strong driver of acute health care utilization after interaction with the criminal legal system. Interventions tailored to the unique needs of individuals with mental illness or substance use disorder are needed for those with recent criminal legal involvement.
Collapse
Affiliation(s)
- Harini Shah
- School of Medicine (Shah), Department of Medicine, Division of General Internal Medicine (Hawks, Walker, Egede), and Center for Advancing Population Science (Hawks, Walker, Egede), Medical College of Wisconsin, Milwaukee
| | - Laura Hawks
- School of Medicine (Shah), Department of Medicine, Division of General Internal Medicine (Hawks, Walker, Egede), and Center for Advancing Population Science (Hawks, Walker, Egede), Medical College of Wisconsin, Milwaukee
| | - Rebekah J Walker
- School of Medicine (Shah), Department of Medicine, Division of General Internal Medicine (Hawks, Walker, Egede), and Center for Advancing Population Science (Hawks, Walker, Egede), Medical College of Wisconsin, Milwaukee
| | - Leonard E Egede
- School of Medicine (Shah), Department of Medicine, Division of General Internal Medicine (Hawks, Walker, Egede), and Center for Advancing Population Science (Hawks, Walker, Egede), Medical College of Wisconsin, Milwaukee
| |
Collapse
|
4
|
Fleury MJ, Rochette L, Gentil L, Grenier G, Lesage A. Predictors of Physician Follow-Up Care Among Patients Affected by an Incident Mental Disorder Episode in Quebec (Canada). CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2024; 69:100-115. [PMID: 37357714 PMCID: PMC10789227 DOI: 10.1177/07067437231182570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/27/2023]
Abstract
OBJECTIVES This study identified predictors of prompt (1+ outpatient physician consultations/within 30 days), adequate (3+/90 days) and continuous (5+/365 days) follow-up care from general practitioners (GPs) or psychiatrists among patients with an incident mental disorder (MD) episode. METHODS Study data were extracted from the Quebec Integrated Chronic Disease Surveillance System (QICDSS), which covers 98% of the population eligible for health-care services under the Quebec (Canada) Health Insurance Plan. This observational epidemiological study investigating the QICDSS from 1 April 1997 to 31 March 2020, is based on a 23-year patient cohort including 12+ years old patients with an incident MD episode (n = 2,670,133). Risk ratios were calculated using Robust Poisson regressions to measure patient sociodemographic and clinical characteristics, and prior service use, which predicted patients being more or less likely to receive prompt, adequate, or continuous follow-up care after their last incident MD episode, controlling for previous MD episodes, co-occurring disorders, and years of entry into the cohort. RESULTS A minority of patients, and fewer over time, received physician follow-up care after an incident MD episode. Women; patients aged 18-64; with depressive or bipolar disorders, co-occurring MDs-substance-related disorders (SRDs) or physical illnesses; those receiving previous GP follow-up care, especially in family medicine groups; patients with higher prior continuity of GP care; and previous high users of emergency departments were more likely to receive follow-up care. Patients living outside the Montreal metropolitan area; those without prior MDs; patients with anxiety, attention deficit hyperactivity, personality, schizophrenia and other psychotic disorders, or SRDs were less likely to receive follow-up care. CONCLUSION This study shows that vulnerable patients with complex clinical characteristics and those with better previous GP care were more likely to receive prompt, adequate or continuous follow-up care after an incident MD episode. Overall, physician follow-up care should be greatly improved.
Collapse
Affiliation(s)
- Marie-Josée Fleury
- Douglas Hospital Research Centre, Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Louis Rochette
- Institut National de Santé Publique du Québec, Quebec City, QC, Canada
| | - Lia Gentil
- Douglas Hospital Research Centre, Montreal, QC, Canada
| | - Guy Grenier
- Douglas Hospital Research Centre, Montreal, QC, Canada
| | - Alain Lesage
- Centre de Recherche de l’Institut Universitaire en Santé Mentale de Montréal, Département de Psychiatrie, Université de Montréal, Montréal, QC, Canada
| |
Collapse
|
5
|
Fleury MJ, Cao Z, Grenier G, Huỳnh C. Profiles of patients with substance-related disorders who dropped out or not from addiction treatment. Psychiatry Res 2023; 329:115532. [PMID: 37837812 DOI: 10.1016/j.psychres.2023.115532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 10/02/2023] [Accepted: 10/06/2023] [Indexed: 10/16/2023]
Abstract
This longitudinal study identified profiles of patients with substance-related disorders (SRD) who did or did not drop out of specialized addiction treatment, integrating various patterns of outpatient service use. Medical administrative databases of Quebec (Canada) were used to investigate a cohort of 16,179 patients with SRD who received specialized addiction treatment. Latent class analysis identified patient profiles, based on multi-year outpatient service use. Four patient profiles related to treatment dropout were identified: patients who did not drop out and were low service users (Profile 1); patients who did not drop out and were high service users (Profile 2); patients who dropped out and were low service users (Profile 3); patients who dropped out and were high service users (Profile 4). Profile 1 had the best health and social conditions, while Profile 4 had the worst. The risks of being frequent emergency department users, being hospitalized or dying were highest in Profile 4, followed by Profiles 3, 2 and 1. Assertive treatment programs may be suited to Profile 4 and intensive case management programs to Profile 3. Collaborative care with higher psychosocial interventions and regularity of care may be extended to Profile 2 and interventions integrating motivational treatment to Profile 1.
Collapse
Affiliation(s)
- Marie-Josée Fleury
- Department of Psychiatry, McGill University, 1033 Pine Avenue West, Montreal, QC, Canada, H3A 1A1; Douglas Hospital Research Centre, 6875 LaSalle Blvd, Montreal, QC, Canada, H4H 1R3.
| | - Zhirong Cao
- Douglas Hospital Research Centre, 6875 LaSalle Blvd, Montreal, QC, Canada, H4H 1R3
| | - Guy Grenier
- Douglas Hospital Research Centre, 6875 LaSalle Blvd, Montreal, QC, Canada, H4H 1R3
| | - Christophe Huỳnh
- Institut universitaire sur les dépendances, Centre intégré universitaire de santé et des services sociaux du Centre-Sud-de-l'Île-de-Montréal, 950, rue de Louvain, Montreal, QC, Canada, H2M 2E8
| |
Collapse
|
6
|
Barbosa J, Organista D, Rodrigues T, Matos AF, Barardo A, Escoval A, Bárbara C, Rodrigues F. Profile of emergency department overuse in hospitalized patients with pulmonary disease and its impact on mortality. Pulmonology 2023:S2531-0437(23)00012-0. [PMID: 36797150 DOI: 10.1016/j.pulmoe.2023.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 01/19/2023] [Accepted: 01/23/2023] [Indexed: 02/16/2023] Open
Abstract
INTRODUCTION AND OBJECTIVES Portugal is one of the countries with the highest number of visits to the emergency department (ED), 31% classified as "non-urgent" or "avoidable." The objectives of our study were to evaluate the size and characteristics of patients with pulmonary disease who overuse the ED, and identify factors associated with mortality. MATERIALS AND METHODS A retrospective cohort study was conducted, based on the medical records of ED frequent users (ED-FU) with pulmonary disease who attended a university hospital center in the northern inner city of Lisbon from January 1 to December 31, 2019. To evaluate mortality, a follow-up until December 31, 2020 was performed. RESULTS Over 5,567 (4.3%) patients were identified as ED-FU and 174 (0.14%) had pulmonary disease as the main clinical condition, accounting for 1,030 ED visits. 77.2% of ED visits were categorized as "urgent/very urgent." A high mean age (67.8 years), male gender, social and economic vulnerability, high burden of chronic disease and comorbidities, with a high degree of dependency, characterized the profile of these patients. A high proportion (33.9%) of patients did not have a family physician assigned and this was the most important factor associated with mortality (p<0.001; OR: 24.394; CI 95%: 6.777-87.805). Advanced cancer disease and autonomy deficit were other clinical factors that most determined the prognosis. CONCLUSIONS Pulmonary ED-FU are a small group of ED-FU who constitute an aged and heterogeneous group with a high burden of chronic disease and disability. The lack of an assigned family physician was the most important factor associated with mortality, as well as advanced cancer disease and autonomy deficit.
Collapse
Affiliation(s)
- J Barbosa
- Pulmonology Unit, Centro Hospitalar Universitário Lisboa Norte (CHULN), Avenida Professor Egas Moniz, MB, 1649-028 Lisbon, Portugal.
| | - D Organista
- Pulmonology Unit, Centro Hospitalar Universitário Lisboa Norte (CHULN), Avenida Professor Egas Moniz, MB, 1649-028 Lisbon, Portugal
| | - T Rodrigues
- Pulmonology Unit, Centro Hospitalar Universitário Lisboa Norte (CHULN), Avenida Professor Egas Moniz, MB, 1649-028 Lisbon, Portugal
| | - A F Matos
- Pulmonology Unit, Centro Hospitalar Universitário Lisboa Norte (CHULN), Avenida Professor Egas Moniz, MB, 1649-028 Lisbon, Portugal
| | - A Barardo
- Hospital Administration, Advisor to the Board of Directors, CHULN, Avenida Professor Egas Moniz, MB, 1649-028 Lisbon, Portugal
| | - A Escoval
- Hospital Administration, Advisor to the Board of Directors, CHULN, Avenida Professor Egas Moniz, MB, 1649-028 Lisbon, Portugal; Center for Research in Public Health (CISP), Center for Integrated Research in Health - Research, Education, and Innovation in Clinical Research and Public Health (CHRC), Escola Nacional de Saúde Pública, Av. Padre Cruz, 1600-560 Lisbon, Portugal
| | - C Bárbara
- Pulmonology Unit, Centro Hospitalar Universitário Lisboa Norte (CHULN), Avenida Professor Egas Moniz, MB, 1649-028 Lisbon, Portugal; Instituto de Saúde Ambiental (ISAMB), Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz, Ed. Egas Moniz, Piso 0, Ala C, 1649-028 Lisbon, Portugal
| | - F Rodrigues
- Pulmonology Unit, Centro Hospitalar Universitário Lisboa Norte (CHULN), Avenida Professor Egas Moniz, MB, 1649-028 Lisbon, Portugal; Instituto de Saúde Ambiental (ISAMB), Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz, Ed. Egas Moniz, Piso 0, Ala C, 1649-028 Lisbon, Portugal
| |
Collapse
|
7
|
Unger S, Orr Z, Alpert EA, Davidovitch N, Shoham-Vardi I. Social and structural determinants of emergency department use among Arab and Jewish patients in Jerusalem. Int J Equity Health 2022; 21:156. [DOI: 10.1186/s12939-022-01698-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 07/02/2022] [Indexed: 11/09/2022] Open
Abstract
Abstract
Background
A growing body of research demonstrates that economic conditions and racial and ethnic disparities result in excessive overuse of emergency departments (EDs) by a small group of socioeconomically marginalized residents. Knowledge and understanding of these issues on the part of the healthcare team can promote equality by providing structurally competent care. This study aims to identify the major social and structural factors related to patterns of ED visits by Arab and Jewish patients in Israel, where access to health services is covered by universal national health insurance.
Methods
A cross-sectional study was conducted using questionnaires of ED patients in a tertiary care medical center in Jerusalem. The hospital is the largest of the three EDs in Jerusalem with over 90,000 adult patient visits a year. The sample was stratified by ethnicity, including 257 Jewish patients and 170 Arab patients. The outcome variable was repeat visits for the same reason to the ED within 30 days.
Results
There were differences between Jewish and Arab patients’ social and structural characteristics, including health status, socioeconomic status, feeling of safety, and social support. There were also significant differences in some of the characteristics of health service utilization patterns, including ED repeat visits, language barriers when seeking healthcare in the community, and seeking information about medical rights. The variables associated with repeat visits were different between the two groups: among the Arab patients, repeat visits to the ED were associated with concerns about personal safety, whereas among the Jewish patients, they were associated with poverty.
Conclusion
The study illustrates the gaps that exist between the Arab and Jewish population in Israel. The findings demonstrated significant differences between populations in both health status and access to health services. In addition, an association was found in each ethnic group between different structural factors and repeat ED requests. This study supports previous theories and findings of the relationship between structural and social factors and patterns of health services utilization.
Collapse
|
8
|
Molina M, Evans J, Montoy JC, Cawley C, Graham-Squire D, Perez K, Raven M, Kanzaria HK. Analysis of Emergency Department Encounters Among High Users of Health Care and Social Service Systems Before and During the COVID-19 Pandemic. JAMA Netw Open 2022; 5:e2239076. [PMID: 36306131 PMCID: PMC9617170 DOI: 10.1001/jamanetworkopen.2022.39076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Although the general US population had fewer emergency department (ED) visits during the COVID-19 pandemic, patterns of use among high users are unknown. OBJECTIVES To examine natural trends in ED visits among high users of health and social services during an extended period and assess whether these trends differed during COVID-19. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study combined data from 9 unique cohorts, 1 for each fiscal year (July 1 to June 30) from 2012 to 2021, and used mixed-effects, negative binomial regression to model ED visits over time and assess ED use among the top 5% of high users of multiple systems during COVID-19. Data were obtained from the Coordinated Care Management System, a San Francisco Department of Public Health platform that integrates medical and social information with service use. EXPOSURES Fiscal year 2020 was defined as the COVID-19 year. MAIN OUTCOMES AND MEASURES Measured variables were age, gender, language, race and ethnicity, homelessness, insurance status, jail health encounters, mental health and substance use diagnoses, and mortality. The main outcome was annual mean ED visit counts. Incidence rate ratios (IRRs) were used to describe changes in ED visit rates both over time and in COVID-19 vs non-COVID-19 years. RESULTS Of the 8967 participants, 3289 (36.7%) identified as White, 3005 (33.5%) as Black, and 1513 (16.9%) as Latinx; and 7932 (88.5%) preferred English. The mean (SD) age was 46.7 (14.2) years, 6071 (67.7%) identified as men, and 7042 (78.5%) had experienced homelessness. A statistically significant decrease was found in annual mean ED visits among high users for every year of follow-up until year 8, with the largest decrease occurring in the first year of follow-up (IRR, 0.41; 95% CI, 0.40-0.43). However, during the pandemic, ED visits decreased 25% beyond the mean reduction seen in prepandemic years (IRR, 0.75; 95% CI, 0.72-0.79). CONCLUSIONS AND RELEVANCE In this study, multiple cohorts of the top 5% of high users of multiple health care systems in San Francisco had sustained annual decreases in ED visits from 2012 to 2021, with significantly greater decreases during COVID-19. Further research is needed to elucidate pandemic-specific factors associated with these findings and understand how this change in use was associated with health outcomes.
Collapse
Affiliation(s)
- Melanie Molina
- Department of Emergency Medicine, University of California, San Francisco
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco
| | - Jennifer Evans
- Benioff Homelessness and Housing Initiative, Center for Vulnerable Populations, University of California, San Francisco
| | - Juan Carlos Montoy
- Department of Emergency Medicine, University of California, San Francisco
| | - Caroline Cawley
- Department of Emergency Medicine, University of California, San Francisco
- Benioff Homelessness and Housing Initiative, Center for Vulnerable Populations, University of California, San Francisco
- Provincial Health Services Authority, Vancouver, British Columbia, Canada
| | - Dave Graham-Squire
- Benioff Homelessness and Housing Initiative, Center for Vulnerable Populations, University of California, San Francisco
| | - Kenneth Perez
- Benioff Homelessness and Housing Initiative, Center for Vulnerable Populations, University of California, San Francisco
| | - Maria Raven
- Department of Emergency Medicine, University of California, San Francisco
- Benioff Homelessness and Housing Initiative, Center for Vulnerable Populations, University of California, San Francisco
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco
| | - Hemal K. Kanzaria
- Department of Emergency Medicine, University of California, San Francisco
- Benioff Homelessness and Housing Initiative, Center for Vulnerable Populations, University of California, San Francisco
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco
| |
Collapse
|
9
|
O'Reilly LM, Dalal AI, Maag S, Perry MT, Card A, Bohrer MB, Hamersly J, Mohammad Nader S, Peterson K, Beiser DG, Gibbons RD, D'Onofrio BM, Musey PI. Computer adaptive testing to assess impairing behavioral health problems in emergency department patients with somatic complaints. J Am Coll Emerg Physicians Open 2022; 3:e12804. [PMID: 36187506 PMCID: PMC9494206 DOI: 10.1002/emp2.12804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objectives To assess: (1) the prevalence of mental health and substance use in patients presenting to the emergency department (ED) through use of a computer adaptive test (CAT‐MH), (2) the correlation among CAT‐MH scores and self‐ and clinician‐reported assessments, and (3) the association between CAT‐MH scores and ED utilization in the year prior and 30 days after enrollment. Methods This was a single‐center observational study of adult patients presenting to the ED for somatic complaints (97%) from May 2019 to March 2020. The main outcomes were computer‐adaptive‐assessed domains of suicidality, depression, anxiety, post‐traumatic stress disorder (PTSD), and substance use. We conducted Pearson correlations and logistic regression for objectives 2 and 3, respectively. Results From a sample of 794 patients, the proportion of those at moderate/severe risk was: 24.1% (suicidality), 8.3% (depression), 16.5% (anxiety), 12.3% (PTSD), and 20.4% (substance use). CAT‐MH domains were highly correlated with self‐report assessments (r = 0.49–0.79). Individuals who had 2 or more ED visits in the prior year had 62% increased odds of being in the intermediate‐high suicide risk category (odds ratio [OR], 1.62; 95% confidence interval [CI], 1.07–2.44) compared to those with zero prior ED visits. Individuals who scored in the intermediate‐high‐suicide risk group had 63% greater odds of an ED visit within 30 days after enrollment compared to those who scored as low risk (OR, 1.63; 95% CI, 1.09, 2.44). Conclusion The CAT‐MH documented that a considerable proportion of ED patients presenting for somatic problems had mental health conditions, even if mild. Mental health problems were also associated with ED utilization.
Collapse
Affiliation(s)
- Lauren M. O'Reilly
- Department of Psychological and Brain Sciences Indiana University Bloomington Indiana USA
| | - Azhar I. Dalal
- Department of Emergency Medicine Indiana University School of Medicine Indianapolis Indiana USA
| | - Serena Maag
- Department of Emergency Medicine Indiana University School of Medicine Indianapolis Indiana USA
| | - Matthew T. Perry
- Department of Emergency Medicine Indiana University School of Medicine Indianapolis Indiana USA
| | - Alex Card
- Department of Emergency Medicine Indiana University School of Medicine Indianapolis Indiana USA
| | - Max B. Bohrer
- Department of Emergency Medicine Indiana University School of Medicine Indianapolis Indiana USA
| | - Jackson Hamersly
- Department of Emergency Medicine Indiana University School of Medicine Indianapolis Indiana USA
| | - Setarah Mohammad Nader
- Department of Emergency Medicine Indiana University School of Medicine Indianapolis Indiana USA
| | - Kelli Peterson
- Department of Emergency Medicine Indiana University School of Medicine Indianapolis Indiana USA
| | - David G. Beiser
- Section of Emergency Medicine Department of Medicine University of Chicago Chicago Illinois USA
| | - Robert D. Gibbons
- Departments of Medicine and Public Health Science (Biostatistics) University of Chicago Chicago Illinois USA
| | - Brian M. D'Onofrio
- Department of Psychological and Brain Sciences Indiana University Bloomington Indiana USA
- Department of Medical Epidemiology & Biostatistics Karolinska Institute Stockholm Sweden
| | - Paul I. Musey
- Department of Emergency Medicine Indiana University School of Medicine Indianapolis Indiana USA
| |
Collapse
|
10
|
Lyon-Scott K, Cohen-Cline H. Associations between Adverse Childhood Experiences and Emergency Department Utilization in an Adult Medicaid Population. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10149. [PMID: 36011783 PMCID: PMC9408230 DOI: 10.3390/ijerph191610149] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 08/12/2022] [Accepted: 08/14/2022] [Indexed: 06/15/2023]
Abstract
Adverse childhood experiences (ACEs) are widely prevalent but unevenly distributed in the United States, with disadvantaged groups, especially those with low socioeconomic status, being more likely to experience them. ACEs have been linked to poor health outcomes in adulthood. In this study, we examined the association between ACEs and emergency department (ED) utilization using a cross-sectional life-course survey of low-income adults matched to Medicaid enrollment and claims data. Surveys were obtained from 2348 Medicaid-enrolled adults in the Portland, OR metropolitan area; 1133 were used in this analysis. We used a two-part regression model to estimate the association between ACE score and both ever using the ED and frequency of ED use in the year after survey completion. We also evaluated a set of potentially protective factors to see if they impacted the relationship between ED use and ACE score. We found that participants with a higher ACE score were more likely to obtain any emergency services care (odds ratio (OR) = 1.11, p = 0.011), but ACE score did not predict how frequently they would utilize those services. Close social relationships were found to be protective against high ED utilization for those with high ACE scores. Upstream prevention efforts that identify places to intervene in childhood and incorporate trauma-informed strategies into ED care in adulthood have the potential to decrease ED use.
Collapse
Affiliation(s)
| | - Hannah Cohen-Cline
- Providence Center for Outcomes Research and Education, Portland, OR 97213, USA
| |
Collapse
|
11
|
Characteristics and Resource Utilization Associated with Frequent Users of Emergency Departments. Emerg Med Int 2022; 2022:8064011. [PMID: 35912391 PMCID: PMC9334063 DOI: 10.1155/2022/8064011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 06/24/2022] [Accepted: 07/01/2022] [Indexed: 11/17/2022] Open
Abstract
Background Frequent emergency department (ED) users place a huge influence and burden on healthcare systems and medical costs. In Taiwan, citizens have very easy access to medical services and the national health insurance (NHI) puts very few restrictions on the frequency and facilities which the patients go to. However, there is still a certain percentage of frequent ED users in Taiwan, and yet, there are few research studies investigating the features of such users and their impact on the healthcare system. We conducted this study to investigate the prevalence and characteristics of the repeated ED users in a tertiary care medical center with more than 80000 emergency visits in a year and hypothesized that frequent ED users have unique medical and social characteristics and results in increased medical expense. Methods We searched the integrated medical database of an urban tertiary medical center in 2017. We compared frequent ED users (≧4 visits/year) with nonfrequent users (<4 visits/year) with regards to the medical history, distance from home to the hospital, main visiting purposes, whether patients had used outpatient care or other medical resources at the same time, and the charge to the patients for each visit. Results In 2017, 2191 patients (3.37%) were listed as frequent users and accounted for 12166 visits (14.20%). Most of the frequent users were over 65 years old (53.1%) and more than half of them had suffered from cancer (55.1%). The most significant features of frequent ED users were male, educational attainment below university, low-income households, drug or food allergies, terminal stage of illness, possession of IC Cards for Severe Illness, hospitalization in the past year, multiple outpatient visits in same year, and with certain medical history including anemia, cerebrovascular accident, congestive heart failure, peptic ulcer disease, ileus, cirrhosis, chronic obstructive pulmonary disease, and psychiatric disease. There were significant differences between frequent and nonfrequent users in disposition and median charge per visit (US$137 vs. $117, p < 0.001). Conclusions Frequent users of ED are a heterogeneous group who usually suffer from multiple chronic diseases. There were higher rates of hospital admission and medical costs among frequent ED users compared to nonfrequent users. In addition to emergency services, frequent users also utilized outpatient resources heavily.
Collapse
|
12
|
Yoon J, Kim MJ, Kim KH, Park J, Shin DW, Kim H, Jeon W, Kim H, Kim J, Park JM. Characteristics of frequent emergency department users in Korea: a 4-year retrospective analysis using Korea Health Panel Study data. Clin Exp Emerg Med 2022; 9:114-119. [PMID: 35843611 PMCID: PMC9288872 DOI: 10.15441/ceem.21.151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 10/21/2021] [Indexed: 11/23/2022] Open
Abstract
Objective We aimed to investigate the characteristics of frequent emergency department (ED) users in Korea. Methods We analyzed the Korea Health Panel Study data of a sampled population from the 2005 Population Census of Korea data, and adults (age ≥18 years) who visited the ED at least once a year between 2014 and 2017 were included in the study. People who visited three or more times a year were classified as frequent users. We compared demographic, socioeconomic, and health-related factors between nonfrequent and frequent users. We used a multivariable logistic regression analysis to determine factors related to frequent ED visits. We also compared the characteristics of ED use in both nonfrequent and frequent users. Results A total of 5,090 panels were included, comprising 6,853 visits. Frequent users were 333 (6.5% of all panels), and their ED visits were 1,364 (19.9% of all ED visits). In the multivariable regression analysis, medical aid coverage (adjusted odds ratio [aOR] of the National Health Service coverage, 0.55; 95% confidence interval [CI], 0.40–0.75), unemployment (aOR of employment, 0.72; 95% CI, 0.56–0.91), prior ward admission in a year (aOR, 2.14; 95% CI, 1.67–2.75), and frequent outpatient department use (aOR, 1.72; 95% CI, 1.35–2.20) were associated with frequent use. Moreover, frequent users visited the ED of public hospitals more often than than nonfrequent users (19.2% vs. 9.8%). Medical problems rather than injury/poisoning were the more common reasons for visiting the ED (84.5% vs. 71.2%). Conclusion We found that frequent ED users were likely to be those with socioeconomic disadvantage or with high demand for medical service. Based on this study, further studies on interventions to reduce frequent ED use are required for better ED services.
Collapse
|
13
|
Stemerman R, Arguello J, Brice J, Krishnamurthy A, Houston M, Kitzmiller R. Identification of social determinants of health using multi-label classification of electronic health record clinical notes. JAMIA Open 2021; 4:ooaa069. [PMID: 34514351 PMCID: PMC8423426 DOI: 10.1093/jamiaopen/ooaa069] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 11/16/2020] [Accepted: 11/20/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Social determinants of health (SDH), key contributors to health, are rarely systematically measured and collected in the electronic health record (EHR). We investigate how to leverage clinical notes using novel applications of multi-label learning (MLL) to classify SDH in mental health and substance use disorder patients who frequent the emergency department. METHODS AND MATERIALS We labeled a gold-standard corpus of EHR clinical note sentences (N = 4063) with 6 identified SDH-related domains recommended by the Institute of Medicine for inclusion in the EHR. We then trained 5 classification models: linear-Support Vector Machine, K-Nearest Neighbors, Random Forest, XGBoost, and bidirectional Long Short-Term Memory (BI-LSTM). We adopted 5 common evaluation measures: accuracy, average precision-recall (AP), area under the curve receiver operating characteristic (AUC-ROC), Hamming loss, and log loss to compare the performance of different methods for MLL classification using the F1 score as the primary evaluation metric. RESULTS Our results suggested that, overall, BI-LSTM outperformed the other classification models in terms of AUC-ROC (93.9), AP (0.76), and Hamming loss (0.12). The AUC-ROC values of MLL models of SDH related domains varied between (0.59-1.0). We found that 44.6% of our study population (N = 1119) had at least one positive documentation of SDH. DISCUSSION AND CONCLUSION The proposed approach of training an MLL model on an SDH rich data source can produce a high performing classifier using only unstructured clinical notes. We also provide evidence that model performance is associated with lexical diversity by health professionals and the auto-generation of clinical note sentences to document SDH.
Collapse
Affiliation(s)
- Rachel Stemerman
- Carolina Health Informatics Program, The University of North Carolina, Chapel Hill, North Carolina, USA
| | - Jaime Arguello
- School of Information and Library Sciences, The University of North Carolina, Chapel Hill, North Carolina, USA
| | - Jane Brice
- Department of Emergency Medicine, The University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Ashok Krishnamurthy
- Department of Computer Science, The University of North Carolina, Chapel Hill, North Carolina, USA
| | - Mary Houston
- Department of Emergency Medicine, The University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Rebecca Kitzmiller
- School of Nursing, The University of North Carolina, Chapel Hill, North Carolina, USA
| |
Collapse
|
14
|
Wang M, Pinilla G, Leung C, Peddada A, Yu E, Akmal S, Cha Y, Dyson L, Kumar A, Kaplin A. Relapse risk factors for patients with comorbid affective disorders and substance abuse disorders from an intensive treatment unit. Am J Addict 2021; 30:461-467. [PMID: 34075661 DOI: 10.1111/ajad.13192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 03/08/2021] [Accepted: 05/02/2021] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The prevalence of substance use disorders (SUD), particularly involving opiates and benzodiazepines, has increased to the detriment of public health and the economy. Here, we evaluate relapse factors among the high-risk demographic of patients with SUD and comorbid affective disorders. METHODS A retrospective chart review of 76 patients discharged after detoxification and simultaneous psychiatric care for concomitant affective disorders and SUDs. Relapse was assessed by two independent evaluators via postdischarge chart review, which included state-wide healthcare utilization, by patient, through healthcare information exchange systems. A Cox Hazards analysis was performed to characterize relapse risk factors. RESULTS Benzodiazepine use, admission through the emergency department (ED) rather than direct admission, frequent ED use in the preceding year, and history of prior attendance at multiple detoxification programs were risk factors for shortened time-to-relapse. Polysubstance use and intravenous drug use prolonged time to relapse. DISCUSSION AND CONCLUSIONS Notable findings include the significant relapse risk associated with benzodiazepine abuse and frequent prior ED utilization. These risk factors could reflect a number of underlying mediators for relapse, including anxiety, disease burden, and malingering. Additionally, this study recapitulates the observation in other patient populations that the majority of health resource utilization is attributed to a small population of patients. SCIENTIFIC SIGNIFICANCE This study is the first to identify relapse predictors among dual-diagnosis affective disorder and SUD patients in survival analysis, and replicates the alarming and largely unknown effect that benzodiazepines have on increasing relapse risk.
Collapse
Affiliation(s)
- Mike Wang
- Departments of Psychiatry and Neurology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Gabriel Pinilla
- Department of Medicine, Universidad Industrial de Santander, Bucaramanga, Santander, Colombia
| | - Curtis Leung
- Johns Hopkins Health System, Baltimore, Maryland, USA
| | - Apoorva Peddada
- Tees, Esk and Wear Valleys NHS Foundation Trust, Chester le Street Health Centre, Chester-le-Street, UK
| | - Eileen Yu
- Departments of Psychiatry and Neurology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sarfraz Akmal
- Department of Medicine, Rutgers University, Newark, New Jersey, USA
| | - Youngjae Cha
- Departments of Psychiatry and Neurology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Laketa Dyson
- Departments of Psychiatry and Neurology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Anupama Kumar
- Departments of Psychiatry and Neurology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Adam Kaplin
- Departments of Psychiatry and Neurology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| |
Collapse
|
15
|
Müller M, Schechter CB, Hautz WE, Sauter TC, Exadaktylos AK, Stock S, Birrenbach T. The development and validation of a resource consumption score of an emergency department consultation. PLoS One 2021; 16:e0247244. [PMID: 33606767 PMCID: PMC7894944 DOI: 10.1371/journal.pone.0247244] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 02/03/2021] [Indexed: 11/18/2022] Open
Abstract
Background Emergency Department (ED) visits and health care costs are increasing globally, but little is known about contributing factors of ED resource consumption. This study aims to analyse and to predict the total ED resource consumption out of the patient and consultation characteristics in order to execute performance analysis and evaluate quality improvements. Methods Characteristics of ED visits of a large Swiss university hospital were summarized according to acute patient condition factors (e.g. chief complaint, resuscitation bay use, vital parameter deviations), chronic patient conditions (e.g. age, comorbidities, drug intake), and contextual factors (e.g. night-time admission). Univariable and multivariable linear regression analyses were conducted with the total ED resource consumption as the dependent variable. Results In total, 164,729 visits were included in the analysis. Physician resources accounted for the largest proportion (54.8%), followed by radiology (19.2%), and laboratory work-up (16.2%). In the multivariable final model, chief complaint had the highest impact on the total ED resource consumption, followed by resuscitation bay use and admission by ambulance. The impact of age group was small. The multivariable final model was validated (R2 of 0.54) and a scoring system was derived out of the predictors. Conclusions More than half of the variation in total ED resource consumption can be predicted by our suggested model in the internal validation, but further studies are needed for external validation. The score developed can be used to calculate benchmarks of an ED and provides leaders in emergency care with a tool that allows them to evaluate resource decisions and to estimate effects of organizational changes.
Collapse
Affiliation(s)
- Martin Müller
- Department of Emergency Medicine, Inselspital, University Hospital, University of Bern, Bern, Switzerland
- Institute of Health Economics and Clinical Epidemiology, University Hospital of Cologne, Cologne, Germany
- * E-mail: (MM); (TB)
| | - Clyde B. Schechter
- Department of Family & Social Medicine & Department of Epidemiology Population Health, Albert Einstein College of Medicine, Bronx, New York, United States of America
| | - Wolf E. Hautz
- Department of Emergency Medicine, Inselspital, University Hospital, University of Bern, Bern, Switzerland
- Center for Educational Measurement, University of Oslo, Oslo, Norway
| | - Thomas C. Sauter
- Department of Emergency Medicine, Inselspital, University Hospital, University of Bern, Bern, Switzerland
| | - Aristomenis K. Exadaktylos
- Department of Emergency Medicine, Inselspital, University Hospital, University of Bern, Bern, Switzerland
| | - Stephanie Stock
- Institute of Health Economics and Clinical Epidemiology, University Hospital of Cologne, Cologne, Germany
| | - Tanja Birrenbach
- Department of Emergency Medicine, Inselspital, University Hospital, University of Bern, Bern, Switzerland
- * E-mail: (MM); (TB)
| |
Collapse
|
16
|
Dufour I, Dubuc N, Chouinard MC, Chiu Y, Courteau J, Hudon C. Profiles of Frequent Geriatric Users of Emergency Departments: A Latent Class Analysis. J Am Geriatr Soc 2020; 69:753-761. [PMID: 33156527 DOI: 10.1111/jgs.16921] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 10/02/2020] [Accepted: 10/15/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND/OBJECTIVES Frequent geriatric users of emergency departments (EDs) represent a complex and heterogeneous population. Identifying their specific subgroups would allow the development of interventions better customized to their needs and characteristics. Thus, this study aimed to develop profiles of frequent geriatric ED users using the individual characteristics of patients. DESIGN This was a retrospective cohort study. SETTING Databases from the Régie de l'assurance maladie du Québec (RAMQ) were utilized. PARTICIPANTSThis study included individuals aged 65 years or older living in the community in the Province of Quebec (Canada), who consulted in an ED at least four times in the year after an ED index date (an ED visit, chosen randomly, during an index period of January 1, 2012 to December 31, 2013) and who had received a diagnosis of ambulatory care-sensitive conditions (ACSCs) in the 2 years preceding the index date. MEASUREMENTS A latent class analysis was used to identify subgroups of frequent geriatric ED users according to their individual characteristics, including ACSC type, dementia, mental health disorders, cancer diagnosis, and comorbidity index. RESULTS The study cohort consisted of 21,393 frequent geriatric ED users. Four groups of frequent geriatric ED users were identified: people with low comorbidity (39.0%), comprising the individuals with the lowest number of physical and mental health conditions; people with cancer (32.7%); people with pulmonaryand cardiac diseases (18.1%); and people with dementia or mental health disorders (10.2%), composed of individuals with the highest proportion of common and severe mental health disease, as well as dementia. This group accounts for the highest use of overall healthcare services. CONCLUSION These profiles will be useful in developing customized interventions addressing the needs of each subgroup of frequent geriatric ED users. More research is needed to bridge the remaining gaps, especially regarding the healthiest frequent geriatric users of EDs.
Collapse
Affiliation(s)
- Isabelle Dufour
- École des sciences infirmières, Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, Canada
| | - Nicole Dubuc
- École des sciences infirmières, Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, Canada
| | | | - Yohann Chiu
- Département de médecine de famille et de médecine d'urgence, Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, Canada
| | - Josiane Courteau
- Groupe de recherche PRIMUS, Centre de recherche du Centre hospitalier universitaire de Sherbrooke (CRCHUS), Sherbrooke, Canada
| | - Catherine Hudon
- Département de médecine de famille et de médecine d'urgence, Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, Canada
| |
Collapse
|
17
|
Janda S, Sindhu S, Watthayu N, Limruangrong P, Viwatwongkasem C, Boonsawat W. Re-attendance at Emergency Department for Elderly Patients with Chronic Obstructive Pulmonary Disease Exacerbation. AGEING INTERNATIONAL 2020. [DOI: 10.1007/s12126-020-09387-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
18
|
Richards JR, Placone TW, Wang CG, van der Linden MC, Derlet RW, Laurin EG. Methamphetamine, Amphetamine, and MDMA Use and Emergency Department Recidivism. J Emerg Med 2020; 59:320-328. [PMID: 32546441 DOI: 10.1016/j.jemermed.2020.04.051] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 04/23/2020] [Accepted: 04/28/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Emergency department (ED) recidivism and the use of amphetamine and associated derivatives such as methamphetamine and MDMA (MAE), are intersecting public health concerns. OBJECTIVE This study aims to determine the frequency of ED recidivism of patients who use MAE and associated factors. METHODS The study was a retrospective 6-year electronic medical record review of patients with MAE-positive toxicology screens and single and multiple ED visits in the span of 12 months. RESULTS There were 7844 ED visits by 5568 MAE-positive patients. Average age was 42 ± 13 years. The majority were male (65%), white (46%), tobacco smokers (55%), and in the psychiatric discharge diagnostic-related group (41%), followed by blunt trauma (20%). Admission rate was 35%, with another 17% transferred to inpatient psychiatric treatment facilities. Occasional (2-5 visits/year), heavy (6-11 visits/year), and super users (≥12 visits/year) altogether accounted for 20% of patients and 43% of visits. Heavy and super users combined represented 2% of patients and 10% of visits, with significant differences for race/ethnicity, health insurance, tobacco smoking, and psychiatric/cardiovascular/trauma discharge diagnostic-related groups. Heavy and super users were less likely to be admitted and more likely to be discharged to an inpatient psychiatric treatment facility. Regression analysis revealed racial/ethnic differences, female gender, and tobacco smoking to be associated with super and heavy use. Heavy users were more likely to have cardiovascular-related discharge diagnoses. CONCLUSIONS The prevalence of ED recidivism in patients who use MAE is similar to published ranges for general ED users. Significant differences in demographics, discharge diagnoses, insurance, smoking, and disposition exist between nonfrequent and frequent ED users.
Collapse
Affiliation(s)
- John R Richards
- Department of Emergency Medicine, University of California Davis Medical Center, Sacramento, California
| | - Taylaur W Placone
- Department of Emergency Medicine, University of California Davis Medical Center, Sacramento, California
| | - Colin G Wang
- Department of Emergency Medicine, University of California Davis Medical Center, Sacramento, California
| | | | - Robert W Derlet
- Department of Emergency Medicine, University of California Davis Medical Center, Sacramento, California
| | - Erik G Laurin
- Department of Emergency Medicine, University of California Davis Medical Center, Sacramento, California
| |
Collapse
|
19
|
Huang PT, Kung PT, Kuo WY, Tsai WC. Impact of family physician integrated care program on decreasing utilization of emergency department visit and hospital admission: a population-based retrospective cohort study. BMC Health Serv Res 2020; 20:470. [PMID: 32456640 PMCID: PMC7249685 DOI: 10.1186/s12913-020-05347-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 05/20/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hospital admission and emergency department(ED) visits are a massive burden in medical expenditures. In 2003, the Taiwanese government developed Family Physician Integrated Care Program (FPIC) to increase the quality of primary care and decrease medical expenditures. This study's goals were to determine whether FPIC decreased hospital admissions and ED visits and identify the factors influencing the outcomes. METHODS This nationwide retrospective cohort study was conducted for the period between 2006 and 2013 by using data obtained from the Taiwan National Health Insurance Research Database. A total of 68,218 individuals were divided into those who joined FPIC and those who did not. We used propensity score matching at a ratio of 1:1 and logistic regression with the generalized estimating equation (GEE) model having a difference-in-difference design to investigate the effects of the FPIC policy on hospital admissions and ED visits in 7 years. RESULTS Using logistic regression with the GEE model with the difference-in-difference design, we found no reduction in ED visits and hospital admissions between the two groups. The participants' risk of hospital admissions increased in the first year after joining FPIC (OR: 1.11, 95% CI: 1.03-1.20, P < .05). However, participants who joined FPIC showed an 8% lower risk of hospital admissions in the sixth and seventh years after joining FPIC, compared with those who did not join FPIC (OR: 0.92, 95% CI: 0.85-1.00, P < .05). CONCLUSIONS FPIC in Taiwan could not decrease medical utilization initially but might reduce hospital admissions in the long term.
Collapse
Affiliation(s)
- Po-Tsung Huang
- Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Pei-Tseng Kung
- Department of Healthcare Administration, Asia University, Taichung, Taiwan.,Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Wen-Yin Kuo
- Department of Health Services Administration, China Medical University, 91, Hsueh-Shih Road, Taichung, Taiwan, 40402
| | - Wen-Chen Tsai
- Department of Health Services Administration, China Medical University, 91, Hsueh-Shih Road, Taichung, Taiwan, 40402.
| |
Collapse
|
20
|
Singer A, Kosowan L, Katz A, Ronksley P, McBrien K, Halas G, Williamson T. Characterizing patients with high use of the primary and tertiary care systems: A retrospective cohort study. Health Policy 2020; 124:291-297. [PMID: 32033837 DOI: 10.1016/j.healthpol.2020.01.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 01/22/2020] [Accepted: 01/27/2020] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To utilize complementary data from primary care and administrative health and social services to describe the clinical, social and demographic characteristics of high users of health care services. METHODS We conducted a retrospective cohort study using data from the Manitoba Primary Care Research Network (MaPCReN) and the Manitoba Centre for Health Policy Research Data Repository in Canada. We assessed data from 193,760 patients with at least one visit to a primary care provider between 2011 and 2016. We defined HU within the following areas: primary care, hospital discharges, length of stay and emergency department visits. Descriptive statistics and logistic regression was used to identify key demographic, social, and medical complexities associated with HU. RESULTS Between 2011 and 2016, 30.8 % of patients had HU during at least one year within at least one area. Among patients with HU, 5 % had persistent HU (HU for ≥2 years) and 359 (0.6 %) had HU across all four definitions. Medical complexity was associated with HU for patients with hospital discharges, ED visits and primary care visits, whereas socially complex patients were more likely to have a longer LOS, and visit the ED. CONCLUSIONS There were unique characteristics in the various HU cohorts including medical, social, and demographic features that can inform strategies aimed at improving health system efficiency in managing patients with HU.
Collapse
Affiliation(s)
- Alexander Singer
- Department of Family Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, D009-780 Bannatyne Ave., Winnipeg, MB, R3T 2N2, Canada.
| | - Leanne Kosowan
- Department of Family Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, D009-780 Bannatyne Ave., Winnipeg, MB, R3T 2N2, Canada.
| | - Alan Katz
- Department of Family Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, D009-780 Bannatyne Ave., Winnipeg, MB, R3T 2N2, Canada; Department of Community Health Sciences and Department of Family Medicine within the Max Rady College of Medicine, Rady Faculty of Health Sciences at the University of Manitoba, 408-727 McDermot Ave., Winnipeg, MB, R3E 3P5, Canada.
| | - Paul Ronksley
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada.
| | - Kerry McBrien
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada.
| | - Gayle Halas
- Department of Family Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, D009-780 Bannatyne Ave., Winnipeg, MB, R3T 2N2, Canada.
| | - Tyler Williamson
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada.
| |
Collapse
|
21
|
Saude J, Baker ML, Axman LM, Swider SM. Applying the Chronic Care Model to Improve Patient Activation at a Nurse-Managed Student-Run Free Clinic for Medically Underserved People. SAGE Open Nurs 2020; 6:2377960820902612. [PMID: 33415266 PMCID: PMC7774398 DOI: 10.1177/2377960820902612] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Accepted: 01/05/2020] [Indexed: 11/16/2022] Open
Abstract
This article describes a practice change intended to improve patient activation, also
described as self-care management, in a sample of uninsured and underinsured patients with
one or more chronic diseases who received care at a nurse-managed student-run free clinic
project. Chronic diseases are the leading causes of death and disability in the United
States. Individuals with chronic illnesses may be uninsured or underinsured and often do
not receive adequate medical management, resulting in complications and unnecessary
hospitalizations. Lack of knowledge related to self-care has been identified as one risk
factor associated with poor health outcomes in medically underserved populations.
Student-run free clinics have emerged to provide care to groups that would otherwise not
receive health care while simultaneously providing experiential learning for healthcare
students. Guided by the Chronic Care Model, an intervention was designed to improve
patients' self-care management and chronic disease care delivery offered by the family
nurse practitioner and baccalaureate nursing students. The evaluation plan for the Patient
Activation Intervention utilized a pretest–posttest design. The Patient Activation Measure
tool was administered at the beginning and end of the intervention. Additional outcomes
were evaluated using a chart audit tool. A total of 19 unique patients, representing 42
free clinic visits, were evaluated during the intervention period. The mean Patient
Activation Measure score was 60.95 (standard deviation ± 12.03) and was indicative of a
good foundational understanding of chronic illness and working toward self-management.
Chi-square and Fischer’s exact test statistics demonstrated a statistically significant
(p < .05) difference in the documentation of
medication reconciliation, patient-centered goals, and self-management education from
baseline to post intervention follow-up appointments. The evidence-based Patient
Activation Intervention demonstrated promise as an effective method to increase patient’s
self-care management and improve patient-centered outcomes for underserved patients when
delivered at a nurse-managed student-run free clinic.
Collapse
Affiliation(s)
- Jason Saude
- California State University San Marcos School of Nursing, CA, USA
| | - Mary L Baker
- California State University San Marcos School of Nursing, CA, USA
| | - Linnea M Axman
- California State University San Marcos School of Nursing, CA, USA
| | | |
Collapse
|
22
|
Community Health Workers: Addressing Client Objectives Among Frequent Emergency Department Users. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2019; 24:146-154. [PMID: 28141671 PMCID: PMC5794249 DOI: 10.1097/phh.0000000000000540] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Supplemental Digital Content is Available in the Text. Objectives: To evaluate effectiveness of a community health worker (CHW) program designed to address client objectives among frequent emergency department (ED) users. Design: Program evaluation using secondary analysis of client objectives from program records. Client objectives were characterized according to the World Health Organization's social determinants of health framework. Hierarchical generalized linear modeling was used to assess factors associated with objective achievement. Setting: An ED and the surrounding community in an economically disadvantaged area of Buffalo, New York. Participants: A total of 1600 adults over age 18 eligible for Medicaid and/or Medicare and who had at least 2 ED visits in the prior year. Intervention: Clients worked with CHWs in the community to identify diverse needs and objectives. Community health workers provided individualized services to help achieve objectives. Main Outcome Measure: Achievement of client-focused objectives. Results: Most objectives pertained to linkage to community resources and health care navigation, emphasizing chronic medical conditions and connection to primary care. Clients and CHWs together achieved 43% of total objectives. Objective achievement was positively associated with greater client engagement in CHW services. Conclusions: Low objective achievement may stem from system- and policy-level barriers, such as lack of affordable housing and access to primary care. Strategies for improving client engagement in CHW services are needed. Community health workers and their clients were most successful in areas in which public health policies and systems made resources easy to access or where the program had formalized relationships with resources, such as primary care.
Collapse
|
23
|
Predictors of Multiple Emergency Department Utilization Among Frequent Emergency Department Users in 3 States. Med Care 2019; 58:137-145. [DOI: 10.1097/mlr.0000000000001228] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
|
24
|
Hanna TN, Duszak R, Chahine A, Zygmont ME, Herr KD, Horný M. The Introduction and Development of the H-index for Imaging Utilizers: A Novel Metric for Quantifying Utilization of Emergency Department Imaging. Acad Emerg Med 2019; 26:1125-1134. [PMID: 31535443 DOI: 10.1111/acem.13765] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 04/05/2019] [Accepted: 04/10/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The objective was to develop a novel metric for quantifying patient-level utilization of emergency department (ED) imaging. METHODS Using 2009 to 2015 Truven Health MarketScan commercial claims and encounters database, all ED visits and associated imaging services were identified. To measure imaging resource intensity, total imaging relative value units (RVUs) were calculated for each patient per ED visit. An individual's annual imaging h-index is defined as the largest number, h, such that h ED visits by that individual in a given year is associated with total medical imaging RVUs of a value of at least h. RESULTS Over 7 years, in a sample of 86,506,362 privately insured individuals (232,919,808 person-years) in all 50 states and the District of Columbia, 38,973,716 ED visits were identified. A total of 9.5% of person-years had one ED visit and 2.7% had two or more (the remainder had none). From 2009 to 2015, the percentage of ED patients undergoing imaging increased from 25.1% to 34.6%. Individuals with two or more ED visits each associated with two or more imaging RVUs (ED imaging h-index ≥ 2) comprised 0.2% of the sample and 1.4% of ED visitors; however, they accounted for 4.0% of ED visits and the use of 18.6% of imaging resources. From 2009 to 2015, imaging resource allocation for such patients increased from 16.5% to 21.0%. CONCLUSIONS The ED imaging h-index allows identification of patients who undergo significant ED imaging, based on a single-digit patient-specific metric that incorporates both annual ED visit number and medical imaging resource intensity per visit. While ED patients with an ED imaging h-index ≥ 2 represented a minuscule fraction of privately insured individuals, they were associated with one-fifth of all ED imaging resources.
Collapse
Affiliation(s)
- Tarek N. Hanna
- Department of Radiology and Imaging Sciences Emory University Atlanta GA
| | - Richard Duszak
- Department of Radiology and Imaging Sciences Emory University Atlanta GA
| | - Amanda Chahine
- Department of Radiology and Imaging Sciences Emory University Atlanta GA
| | - Matthew E. Zygmont
- Department of Radiology and Imaging Sciences Emory University Atlanta GA
| | - Keith D. Herr
- Department of Radiology and Imaging Sciences Emory University Atlanta GA
| | - Michal Horný
- Department of Radiology and Imaging Sciences Emory University Atlanta GA
- Department of Health Policy and Management Rollins School of Public Health Emory University Atlanta GA
| |
Collapse
|
25
|
Giannouchos TV, Kum HC, Foster MJ, Ohsfeldt RL. Characteristics and predictors of adult frequent emergency department users in the United States: A systematic literature review. J Eval Clin Pract 2019; 25:420-433. [PMID: 31044484 DOI: 10.1111/jep.13137] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 03/08/2019] [Accepted: 03/11/2019] [Indexed: 11/29/2022]
Abstract
STUDY OBJECTIVE We conducted a systematic literature review to identify and to update patient characteristics and contextual factors for adult frequent emergency department users (FEDUs) compared with non-FEDU in an era where the US health care system underwent substantial changes. METHODS We searched MEDLINE, CINAHL, and EMBASE to identify all relevant articles after 2010 through July 2018 that describe FEDU. We included US studies on adult FEDU only and excluded studies on specific subgroups of FEDU. We included demographic, clinical, and health care utilization information, and two reviewers independently evaluated the studies using the Joanna Briggs Institute Critical Appraisal tool. RESULTS The 11 studies included in the review indicated that FEDU were 4% to 16% of total ED users but accounted for 14% to 47% of ED visits, with six to nine visits per year on average. The majority of FEDU were young or middle-aged adults, females, of low socioeconomic status and high school or less education, with public insurance, multiple primary care provider visits, and chronic conditions. Fair or poor self-perceived health status, unemployment, unmet needs from primary care providers (PCPs), mental health, and substance abuse were predictors of FEDU. CONCLUSION FEDUs are disproportionally sicker and are also heavy users of non-ED health care service providers. The limited data for non-ED health services use in facility-specific studies of FEDU may contribute to findings in such studies that complex and unmet needs from PCPs contributed to ED visits. This suggests the need for more comprehensive data analysis beyond a few sites that can inform systemic management approaches.
Collapse
Affiliation(s)
- Theodoros V Giannouchos
- Department of Health Policy & Management, School of Public Health, Texas A&M University, College Station, TX, USA.,Population Informatics Lab, Texas A&M University, College Station, TX, USA
| | - Hye-Chung Kum
- Department of Health Policy & Management, School of Public Health, Texas A&M University, College Station, TX, USA.,Population Informatics Lab, Texas A&M University, College Station, TX, USA.,Department of Computer Science & Engineering, Texas A&M University, College Station, TX, USA.,Department of Industrial & Systems Engineering, Texas A&M University, College Station, TX, USA
| | - Margaret J Foster
- Medical Sciences Library, Texas A&M University, College Station, TX, USA
| | - Robert L Ohsfeldt
- Department of Health Policy & Management, School of Public Health, Texas A&M University, College Station, TX, USA.,Population Informatics Lab, Texas A&M University, College Station, TX, USA
| |
Collapse
|
26
|
Wennman I, Wittholt M, Carlström E, Carlsson T, Khorram-Manesh A. Urgent care centre in Sweden-the integration of teams and perceived effects. Int J Health Plann Manage 2019; 34:1205-1216. [PMID: 30977572 DOI: 10.1002/hpm.2790] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 03/29/2019] [Indexed: 11/06/2022] Open
Abstract
An urgent care centre (UCC) is an upcoming trend in Swedish health care. Although UCCs have been established in other countries, their effectiveness and value have not yet been studied in Sweden. The aim of this study was to investigate the interaction between the UCC and emergency department (ED) by using validated evaluation models. One adult ED (AED) and one child ED (CED), together with a newly established UCC nearby, were included in this study. The interaction between the UCC team and the ED teams was studied by using two evaluation models: one for evaluation of integration and the other one for the evaluation of the effects, in terms of perceived relief of the ED after the establishment of the UCC. It was evident that integration was achieved early on in the course of the follow-up. However, the perception of integration varied between low (EDs) and high collaboration (UCC). All respondents of the EDs indicated relief, in terms of pace and pressure on the ED since the UCC was established. This study indicates that the grade of integration and collaboration between UCC and ED can be achieved automatically and very early during the establishment. It also shows that UCCs can be a competent complement to EDs and alleviate some of the heavy pressure placed on EDs due to ED overcrowding.
Collapse
Affiliation(s)
- Ingela Wennman
- Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Malin Wittholt
- Region Västra Götaland, Competence Centre for Project and Change Management, Gothenburg, Sweden
| | - Eric Carlström
- Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,USN School of Business, University of South-Eastern Norway, Notodden, Norway
| | - Tobias Carlsson
- Emergency Medicine Development Centre, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Amir Khorram-Manesh
- Institute of Clinical Sciences, Department of Surgery, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| |
Collapse
|
27
|
Kim JJ, Kwok ESH, Cook OG, Calder LA. Characterizing Highly Frequent Users of a Large Canadian Urban Emergency Department. West J Emerg Med 2018; 19:926-933. [PMID: 30429923 PMCID: PMC6225932 DOI: 10.5811/westjem.2018.9.39369] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 09/10/2018] [Accepted: 09/24/2018] [Indexed: 11/23/2022] Open
Abstract
Introduction Highly frequent users (HFU) of the emergency department (ED) are a poorly defined population. This study describes patient and visit characteristics for Canadian ED HFU and patient subgroups with mental illness, substance misuse, or ≥ 30 yearly ED visits. Methods We reviewed health records from a random selection of adult patients whose visit frequency comprised the 99th percentile of yearly ED visits to The Ottawa Hospital. We excluded scheduled repeat ED assessments. We collected the following: 1) patient characteristics – age, sex, and comorbidities; and 2) ED visit characteristics – diagnosis category, length of stay, presentation time, consultation services, and final disposition. Two reviewers collected data, and we performed an inter-rater review to measure agreement. Results We analyzed 3,164 ED visits for 261 patients in all subgroups overall. Within the HFU random selection, mean age was 53.4 ± 1.3, and 55.6% were female. Most patients had a fixed address (88.9%), and family physician (87.2%). Top ED diagnoses included musculoskeletal pain (9.6%), alcohol intoxication (8.5%), and abdominal pain (8.4%). Allied health (social work, geriatric emergency medicine, or community care access centre) was consulted for 5.9% of visits. In 52.7% of these cases, allied health services were not available at the time of presentation. Conclusion HFU are a complex population who represent a marked proportion of annual ED visits. Our data indicate that there are opportunities to improve the current approaches to care. Future work examining ED-based screening and multi-disciplinary approaches for HFU may help reduce frequent ED presentations, and better serve this vulnerable population.
Collapse
Affiliation(s)
- Julie J Kim
- University of Ottawa, Department of Emergency Medicine, Ottawa, Ontario, Canada
| | - Edmund S H Kwok
- University of Ottawa, Department of Emergency Medicine, Ottawa, Ontario, Canada.,Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Olivia G Cook
- University of Ottawa, Department of Undergraduate Medicine, Ottawa, Ontario, Canada
| | - Lisa A Calder
- University of Ottawa, Department of Emergency Medicine, Ottawa, Ontario, Canada.,Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| |
Collapse
|
28
|
Moulin A, Evans EJ, Xing G, Melnikow J. Substance Use, Homelessness, Mental Illness and Medicaid Coverage: A Set-up for High Emergency Department Utilization. West J Emerg Med 2018; 19:902-906. [PMID: 30429919 PMCID: PMC6225935 DOI: 10.5811/westjem.2018.9.38954] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 09/21/2018] [Accepted: 09/27/2018] [Indexed: 11/11/2022] Open
Abstract
Introduction Frequent users of emergency departments (ED) account for 21–28% of all ED visits nationwide. The objective of our study was to identify characteristics unique to patients with psychiatric illness who are frequent ED users for mental health care. Understanding unique features of this population could lead to better care and lower healthcare costs. Methods This retrospective analysis of adult ED visits for mental healthcare from all acute care hospitals in California from 2009–2014 used patient-level data from California’s Office of Statewide Health Planning and Development. We calculated patient demographic and visit characteristics for patients with a primary diagnosis of a mental health disorder as a percentage of total adult ED visits. Frequent ED users were defined as patients with more than four visits in a 12-month period. We calculated adjusted rate ratios (aRR) to assess the association between classification as an ED frequent user and patient age, sex, payer, homelessness, and substance use disorder. Results In the study period, 846,867 ED visits for mental healthcare occurred including 238,892 (28.2%) visits by frequent users. Patients with a primary mental health diagnosis and a co-occurring substance use diagnosis in the prior 12 months (77% vs. 37%, aRR [4.02], 95% confidence interval [CI] [3.92–4.12]), homelessness (2.9% vs 1.1%, odds ratio [1.35], 95% [CI] [1.27–1.43]) were more likely to be frequent users. Those covered by Medicare (aRR [3.37], 95% CI [3.20–3.55]) or the state’s Medicaid program Medi-Cal (aRR [3.10], 95% CI [2.94–3.25]) were also more likely to be frequent users compared with those with private insurance coverage. Conclusion Patients with substance use disorders, homelessness and public healthcare coverage are more likely to be frequent users of EDs for mental illness. Substance use and housing needs are important factors to address in this population.
Collapse
Affiliation(s)
- Aimee Moulin
- University of California, Davis, Department of Emergency Medicine, Department of Psychiatry, Davis, California
| | - Ethan J Evans
- University of California, Davis, Center for Healthcare Policy and Research, Davis, California
| | - Guibo Xing
- University of California, Davis, Center for Healthcare Policy and Research, Davis, California
| | - Joy Melnikow
- University of California, Davis, Center for Healthcare Policy and Research, Davis, California.,University of California, Davis, Department of Family and Community Medicine, Davis, California
| |
Collapse
|
29
|
Chow JY, Comulada WS, Gildner JL, Desmond KA, Leibowitz AA. Association between Federally Qualified Health Center usage and emergency department utilization among California's HIV-infected Medicaid beneficiaries, 2009. AIDS Care 2018; 31:519-527. [PMID: 30238793 DOI: 10.1080/09540121.2018.1524112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Federally Qualified Health Centers (FQHCs) have long been important sources of care for publicly insured people living with HIV. FQHC users have historically used emergency departments (EDs) at a higher-than-average rate. This paper examines whether this greater use relates to access difficulties in FQHCs or to characteristics of FQHC users. Zero-inflated Poisson models were used to estimate how FQHC use related to the odds of being an ED user and annual number of ED visits, using claims data on 6,284 HIV-infected California Medicaid beneficiaries in 2008-2009. FQHC users averaged significantly greater numbers of annual ED visits than non-FQHC users and those with no outpatient usage (1.89, 1.59, and 1.70, respectively; P = 0.043). FQHC users had higher odds of being ED users (OR = 1.14; 95%CI 1.02-1.27). In multivariable analyses, FQHC clients had higher odds of ED usage controlling for demographic and service characteristics (OR = 1.15; 95%CI 1.02-1.30) but not when medical characteristics were included (OR = 1.08; 95%CI 0.95-1.24). Among ED users, FQHC use was not significantly associated with the number of ED visits in our models (rate ratio (RR) = 1.00; 95%CI 0.87-1.15). The overall difference in mean annual ED visits observed between FQHC and non-FQHC groups was reduced to insignificance (1.75; 95% CI 1.59-1.92 vs 1.70; 95%CI 1.54-1.85) after adjusting for demographic, service, and medical characteristics. Overall, FQHC users had higher ED utilization than non-FQHC users, but the disparity was largely driven by differences in underlying medical characteristics.
Collapse
Affiliation(s)
- Jeremy Y Chow
- a Department of Internal Medicine, Division of Infectious Diseases, David Geffen School of Medicine , University of California , Los Angeles , CA , USA
| | - W Scott Comulada
- b Department of Psychiatry and Biobehavioral Sciences , University of California , Los Angeles , CA , USA
| | - Jennifer L Gildner
- c Department of Public Policy, Luskin School of Public Affairs , University of California , Los Angeles , CA , USA
| | - Katherine A Desmond
- c Department of Public Policy, Luskin School of Public Affairs , University of California , Los Angeles , CA , USA
| | - Arleen A Leibowitz
- c Department of Public Policy, Luskin School of Public Affairs , University of California , Los Angeles , CA , USA
| |
Collapse
|
30
|
Harcourt DI, McDonald CJ, Cartlidge-Gann L, Brown NJ, Rayner K. Frequent presentations to emergency departments and the collaborative community and emergency response. JOURNAL OF INTEGRATED CARE 2018. [DOI: 10.1108/jica-02-2018-0015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
Patient dependence on an emergency department (ED) for ongoing, non-urgent health care is a complex issue related to poor mental and physical health, disability, previous trauma, social disadvantage and lack of social supports. Working Together to Connect Care is an innovative program that provides an assertive community case management approach coupled with an ED management plan to support people who frequently attend the Royal Brisbane and Women’s Hospital ED. The program, which is yet to be fully evaluated, currently helps to manage a large number of patients with a wide variety of complex needs. To demonstrate the scope and capabilities of the program, the purpose of this paper is to present a series of case studies of patients who frequently attended the ED and subsequently became program participants.
Design/methodology/approach
A series of five case studies is used to illustrate the variety of patient characteristics and available management pathways. Outcomes, including rates of ED attendance, at five months after program commencement are also described.
Findings
The variety of characteristics and experiences of the patients in the case studies is representative of the program cohort as a whole. Program participation has resulted in improved patient outcomes as demonstrated by crisis resolution, housing stability, engagement with primary health care and reduced frequency of ED presentations.
Originality/value
A personalized, integrated-care management approach is both flexible and effective in responding to the complex needs of five patients who frequently attend EDs.
Collapse
|
31
|
Komenda P, Tangri N, Klajncar E, Eng A, Di Nella M, Hiebert B, Strome T, Lobato de Faria R, Zacharias JM, Verrelli M, Sood MM, Rigatto C. Patterns of emergency department utilization by patients on chronic dialysis: A population-based study. PLoS One 2018; 13:e0195323. [PMID: 29664922 PMCID: PMC5903639 DOI: 10.1371/journal.pone.0195323] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 03/20/2018] [Indexed: 11/18/2022] Open
Abstract
Importance Patients on dialysis are often elderly and frail, with multiple comorbid conditions, and are heavy users of Emergency Department (ED) services. However, objective data on the frequency and pattern of ED utilization by dialysis patients are sparse. Such data could identify periods of highest risk for ED visits and inform health systems interventions to mitigate these risks and improve outcomes Objective To describe the pattern and frequency of presentation to ER by dialysis patients Design Retrospective cohort study using administrative data collected over ten years (2000–2009) in the Province of Manitoba, Canada. Setting Patients presenting to any of 9 ED’s in Winnipeg and Brandon Manitoba. These departments serve >90% of the population of Manitoba, Canada (population 1.2 million). Participants All patients presenting to an ED in any of 9 emergency departments in Manitoba, Canada. Exposure Dialysis status Main outcomes Presentation to the ED Results Over 2.1 million ED visits by more than 1.2 million non-dialysis patients and 17,782 ED visits by 3257 dialysis patients were included. Dialysis patients presented 8.5 times more frequently to the ED than the general population (age and sex adjusted, p<0.001). For dialysis patients, ED utilization was significantly higher following the long interdialytic interval (33.6% higher Mondays and 19.5% higher Tuesdays vs. other days of the week, p<0.001) and was 10-fold higher in the 7 days before and after the initiation of dialysis. Conclusion and relevance The heavy use of ED services by dialysis patients spikes upward following the long interdialytic interval and also in the week before and after dialysis initiation. The relative risks associated with these vulnerable periods were much higher than those reported for clinical patient characteristics. We propose that intrinsic gaps in the structure of care delivery (e.g. 3 times a week dialysis, imperfect surveillance and clinical monitoring of patients with low GFR) may be the fundamental drivers of this periodicity. Strategies to mitigate this excess health risk are needed.
Collapse
Affiliation(s)
- Paul Komenda
- Faculty of Medicine, University of Manitoba, Winnipeg, MB, Canada
- Manitoba Renal Program, Winnipeg, MB, Canada
- Chronic Disease Innovation Centre, Seven Oaks General Hospital, Winnipeg, MB, Canada
| | - Navdeep Tangri
- Faculty of Medicine, University of Manitoba, Winnipeg, MB, Canada
- Manitoba Renal Program, Winnipeg, MB, Canada
- Chronic Disease Innovation Centre, Seven Oaks General Hospital, Winnipeg, MB, Canada
| | - Evan Klajncar
- Faculty of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Amanda Eng
- Faculty of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Michelle Di Nella
- Chronic Disease Innovation Centre, Seven Oaks General Hospital, Winnipeg, MB, Canada
| | - Brett Hiebert
- Cardiac Sciences Program, St. Boniface General Hospital, Winnipeg, MB, Canada
| | - Trevor Strome
- Winnipeg Regional Health Authority, Emergency Department Program, Winnipeg, MB, Canada
| | | | - James M. Zacharias
- Faculty of Medicine, University of Manitoba, Winnipeg, MB, Canada
- Manitoba Renal Program, Winnipeg, MB, Canada
- Chronic Disease Innovation Centre, Seven Oaks General Hospital, Winnipeg, MB, Canada
| | - Mauro Verrelli
- Faculty of Medicine, University of Manitoba, Winnipeg, MB, Canada
- Manitoba Renal Program, Winnipeg, MB, Canada
| | - Manish M. Sood
- Chronic Disease Innovation Centre, Seven Oaks General Hospital, Winnipeg, MB, Canada
- University of Ottawa, Ottawa, ON, Canada
| | - Claudio Rigatto
- Faculty of Medicine, University of Manitoba, Winnipeg, MB, Canada
- Manitoba Renal Program, Winnipeg, MB, Canada
- Chronic Disease Innovation Centre, Seven Oaks General Hospital, Winnipeg, MB, Canada
- * E-mail:
| |
Collapse
|
32
|
Schinasi LH, Auchincloss AH, Forrest CB, Diez Roux AV. Using electronic health record data for environmental and place based population health research: a systematic review. Ann Epidemiol 2018; 28:493-502. [PMID: 29628285 DOI: 10.1016/j.annepidem.2018.03.008] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 03/13/2018] [Accepted: 03/16/2018] [Indexed: 12/21/2022]
Abstract
PURPOSE We conducted a systematic review of literature published on January 2000-May 2017 that spatially linked electronic health record (EHR) data with environmental information for population health research. METHODS We abstracted information on the environmental and health outcome variables and the methods and data sources used. RESULTS The automated search yielded 669 articles; 128 articles are included in the full review. The number of articles increased by publication year; the majority (80%) were from the United States, and the mean sample size was approximately 160,000. Most articles used cross-sectional (44%) or longitudinal (40%) designs. Common outcomes were health care utilization (32%), cardiometabolic conditions/obesity (23%), and asthma/respiratory conditions (10%). Common environmental variables were sociodemographic measures (42%), proximity to medical facilities (15%), and built environment and land use (13%). The most common spatial identifiers were administrative units (59%), such as census tracts. Residential addresses were also commonly used to assign point locations, or to calculate distances or buffer areas. CONCLUSIONS Future research should include more detailed descriptions of methods used to geocode addresses, focus on a broader array of health outcomes, and describe linkage methods. Studies should also explore using longitudinal residential address histories to evaluate associations between time-varying environmental variables and health outcomes.
Collapse
Affiliation(s)
- Leah H Schinasi
- Department of Environmental and Occupational Health, Dornsife School of Public Health, Drexel University, Philadelphia, PA; Urban Health Collaborative, Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA.
| | - Amy H Auchincloss
- Urban Health Collaborative, Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA; Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA
| | | | - Ana V Diez Roux
- Urban Health Collaborative, Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA; Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA
| |
Collapse
|
33
|
Cunningham SD, Magriples U, Thomas JL, Kozhimannil KB, Herrera C, Barrette E, Shebl FM, Ickovics JR. Association Between Maternal Comorbidities and Emergency Department Use Among a National Sample of Commercially Insured Pregnant Women. Acad Emerg Med 2017; 24:940-947. [PMID: 28471532 DOI: 10.1111/acem.13215] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 04/18/2017] [Accepted: 04/25/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Evidence suggests that, despite routine engagement with the health system, pregnant women commonly seek emergency care. The objectives of this study were to examine the association between maternal comorbidities and emergency department (ED) use among a national sample of commercially insured pregnant women. METHODS We conducted a retrospective cohort study using multipayer medical claims data maintained by the Health Care Cost Institute for women ages 18 to 44 years with a live singleton birth in 2011 (N = 157,786). The association between common maternal comorbidities (e.g., hypertension, gestational diabetes) and ED use during pregnancy was examined using multilevel models, while controlling for age, region, and residential zip code. RESULTS Twenty percent (n = 31,413) of pregnant women had one or more ED visit (mean ± SD = 1.52 ± 1.15). Among those who used the ED, 29% had two or more visits, and 11% had three or more visits. Emergency care seekers were significantly more likely to have one or more comorbid condition compared to those with no emergency care: 30% versus 21%, respectively (p < 0.001). Pregnant women with asthma had 2.5 times the likelihood of having had any ED visit (adjusted odds ratio [AOR] = 2.46, 95% confidence interval [CI] = 2.32-2.62). There was a significant increase in the probability (approximately 50%) of ED use among pregnant women with diabetes (AOR = 1.47, 95% CI = 1.33-1.63) or hypertension (AOR = 1.49, 95% CI = 1.43-1.55) or who were obese (AOR = 1.55, 95% CI = 1.47-1.64). Increased odds associated with gestational diabetes were more modest, resulting in a 13% increased odds of using the ED (AOR = 1.13, 95% CI = 1.07-1.18). Less than 0.6% of pregnant women (n = 177) received emergency care that resulted in a hospital admission. The admission rate was 0.4% (189 admissions/47,608 ED visits). CONCLUSIONS Among pregnant women, comorbidity burden was associated with more ED utilization. Efforts to reduce acute unscheduled care and improve care coordination during pregnancy should target interventions to patient comorbidity.
Collapse
Affiliation(s)
| | | | | | | | - Carolina Herrera
- Department of Health Law; Policy and Management; Boston University School of Public Health; Boston MA
| | | | | | | |
Collapse
|
34
|
Saef SH, Carr CM, Bush JS, Bartman MT, Sendor AB, Zhao W, Su Z, Zhang J, Marsden J, Arnaud JC, Melvin CL, Lenert L, Moran WP, Mauldin PD, Obeid JS. A Comprehensive View of Frequent Emergency Department Users Based on Data from a Regional HIE. South Med J 2017; 109:434-9. [PMID: 27364030 DOI: 10.14423/smj.0000000000000488] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES A small but significant number of patients make frequent emergency department (ED) visits to multiple EDs within a region. We have a unique health information exchange (HIE) that includes every ED encounter in all hospital systems in our region. Using our HIE we were able to characterize all frequent ED users in our region, regardless of hospital visited or payer class. The objective of our study was to use data from an HIE to characterize patients in a region who are frequent ED users (FEDUs). METHODS We constructed a database from a cohort of adult patients (18 years old or older) with information in a regional HIE for a 1-year period beginning in April 2012. Patients were defined as FEDUs (those who made four or more visits during the study period) and non-FEDUs (those who made fewer than four ED visits during the study period). Predictor variables included age, race, sex, payer class, county of residence, and International Classification of Diseases, Ninth Revision codes. Bivariate (χ(2)) and multivariate (logistic regression) analyses were performed to determine associations between predictor variables and the outcome of being a FEDU. RESULTS The database contained 127,672 patients, 12,293 (9.6%) of whom were FEDUs. Logistic regression showed the following patient characteristics to be significantly associated with the outcome of being a FEDU: age 35 to 44 years; African American race; Medicaid, Medicare, and dual-pay payer class; and International Classification of Diseases, Ninth Revision codes 630 to 679 (complications of pregnancy, childbirth, and puerperium), 780 to 799 (ill-defined conditions), 280 to 289 (diseases of the blood), 290-319 (mental disorders), 680 to 709 (diseases of the skin and subcutaneous tissue), 710 to 739 (musculoskeletal and connective tissue disease), 460 to 519 (respiratory disease), and 520 to 579 (digestive disease). No significant differences were noted between men and women. CONCLUSIONS Data from an HIE can be used to describe all of the patients within a region who are FEDUs, regardless of the hospital system they visited. This information can be used to focus care coordination efforts and link appropriate patients to a medical home. Future studies can be designed to learn the reasons why patients become FEDUs, and interventions can be developed to address deficiencies in health care that result in frequent ED visits.
Collapse
Affiliation(s)
- Steven Howard Saef
- From the Divisions of Emergency Medicine and General Internal Medicine and Geriatrics, the Department of Public Health Sciences, the South Carolina Clinical and Translational Research Institute, and the Center for Biomedical Informatics, Medical University of South Carolina, Charleston
| | - Christine Marie Carr
- From the Divisions of Emergency Medicine and General Internal Medicine and Geriatrics, the Department of Public Health Sciences, the South Carolina Clinical and Translational Research Institute, and the Center for Biomedical Informatics, Medical University of South Carolina, Charleston
| | - Jeffrey S Bush
- From the Divisions of Emergency Medicine and General Internal Medicine and Geriatrics, the Department of Public Health Sciences, the South Carolina Clinical and Translational Research Institute, and the Center for Biomedical Informatics, Medical University of South Carolina, Charleston
| | - Marc T Bartman
- From the Divisions of Emergency Medicine and General Internal Medicine and Geriatrics, the Department of Public Health Sciences, the South Carolina Clinical and Translational Research Institute, and the Center for Biomedical Informatics, Medical University of South Carolina, Charleston
| | - Adam B Sendor
- From the Divisions of Emergency Medicine and General Internal Medicine and Geriatrics, the Department of Public Health Sciences, the South Carolina Clinical and Translational Research Institute, and the Center for Biomedical Informatics, Medical University of South Carolina, Charleston
| | - Wenle Zhao
- From the Divisions of Emergency Medicine and General Internal Medicine and Geriatrics, the Department of Public Health Sciences, the South Carolina Clinical and Translational Research Institute, and the Center for Biomedical Informatics, Medical University of South Carolina, Charleston
| | - Zemin Su
- From the Divisions of Emergency Medicine and General Internal Medicine and Geriatrics, the Department of Public Health Sciences, the South Carolina Clinical and Translational Research Institute, and the Center for Biomedical Informatics, Medical University of South Carolina, Charleston
| | - Jingwen Zhang
- From the Divisions of Emergency Medicine and General Internal Medicine and Geriatrics, the Department of Public Health Sciences, the South Carolina Clinical and Translational Research Institute, and the Center for Biomedical Informatics, Medical University of South Carolina, Charleston
| | - Justin Marsden
- From the Divisions of Emergency Medicine and General Internal Medicine and Geriatrics, the Department of Public Health Sciences, the South Carolina Clinical and Translational Research Institute, and the Center for Biomedical Informatics, Medical University of South Carolina, Charleston
| | - J Christophe Arnaud
- From the Divisions of Emergency Medicine and General Internal Medicine and Geriatrics, the Department of Public Health Sciences, the South Carolina Clinical and Translational Research Institute, and the Center for Biomedical Informatics, Medical University of South Carolina, Charleston
| | - Cathy L Melvin
- From the Divisions of Emergency Medicine and General Internal Medicine and Geriatrics, the Department of Public Health Sciences, the South Carolina Clinical and Translational Research Institute, and the Center for Biomedical Informatics, Medical University of South Carolina, Charleston
| | - Leslie Lenert
- From the Divisions of Emergency Medicine and General Internal Medicine and Geriatrics, the Department of Public Health Sciences, the South Carolina Clinical and Translational Research Institute, and the Center for Biomedical Informatics, Medical University of South Carolina, Charleston
| | - William P Moran
- From the Divisions of Emergency Medicine and General Internal Medicine and Geriatrics, the Department of Public Health Sciences, the South Carolina Clinical and Translational Research Institute, and the Center for Biomedical Informatics, Medical University of South Carolina, Charleston
| | - Patrick D Mauldin
- From the Divisions of Emergency Medicine and General Internal Medicine and Geriatrics, the Department of Public Health Sciences, the South Carolina Clinical and Translational Research Institute, and the Center for Biomedical Informatics, Medical University of South Carolina, Charleston
| | - Jihad S Obeid
- From the Divisions of Emergency Medicine and General Internal Medicine and Geriatrics, the Department of Public Health Sciences, the South Carolina Clinical and Translational Research Institute, and the Center for Biomedical Informatics, Medical University of South Carolina, Charleston
| |
Collapse
|
35
|
Challenges and Opportunities to Engaging Emergency Medical Service Providers in Substance Use Research: A Qualitative Study. Prehosp Disaster Med 2017; 32:148-155. [PMID: 28122657 DOI: 10.1017/s1049023x16001424] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Introduction Research suggests Emergency Medical Services (EMS) over-use in urban cities is partly due to substance users with limited access to medical/social services. Recent efforts to deliver brief, motivational messages to encourage these individuals to enter treatment have not considered EMS providers. Problem Little research has been done with EMS providers who serve substance-using patients. The EMS providers were interviewed about participating in a pilot program where they would be trained to screen their patients for substance abuse and encourage them to enter drug treatment. METHODS Qualitative interviews were conducted with Baltimore City Fire Department (BCFD; Baltimore, Maryland USA) EMS providers (N=22). Topics included EMS misuse, work demands, and views on participating in the pilot program. Interviews were transcribed and analyzed using grounded theory and constant-comparison. RESULTS Participants were mostly white (68.1%); male (68.2%); with Advanced Life Skills training (90.9%). Mean age was 37.5 years. Providers described the "frequent flyer problem" (eg, EMS over-use by a few repeat non-emergent cases). Providers expressed disappointment with local health delivery due to resource limitations and being excluded from decision making within their administration, leading to reduced team morale and burnout. Nonetheless, providers acknowledged they are well-positioned to intervene with substance-using patients because they are in direct contact and have built rapport with them. They noted patients might be most receptive to motivational messages immediately after overdose revival, which several called "hitting their bottom." Several stated that involvement with the proposed study would be facilitated by direct incorporation into EMS providers' current workflow. Many recommended that research team members accompany EMS providers while on-call to observe their day-to-day work. Barriers identified by the providers included time constraints to intervene, limited knowledge of substance abuse treatment modalities, and fearing negative repercussions from supervisors and/or patients. Despite reservations, several EMS providers expressed inclination to deliver brief motivational messages to encourage substance-using patients to consider treatment, given adequate training and skill-building. CONCLUSIONS Emergency Medical Service providers may have many demands, including difficult case time/resource limitations. Even so, participants recognized their unique position as first responders to deliver motivational, harm-reduction messages to substance-using patients during transport. With incentivized training, implementing this program could be life- and cost-saving, improving emergency and behavioral health services. Findings will inform future efforts to connect substance users with drug treatment, potentially reducing EMS over-use in Baltimore. Maragh-Bass AC , Fields JC , McWilliams J , Knowlton AR . Challenges and opportunities to engaging Emergency Medical Service providers in substance use research: a qualitative study. Prehosp Disaster Med. 2017;32(2):148-155.
Collapse
|
36
|
Legramante JM, Morciano L, Lucaroni F, Gilardi F, Caredda E, Pesaresi A, Coscia M, Orlando S, Brandi A, Giovagnoli G, Di Lecce VN, Visconti G, Palombi L. Frequent Use of Emergency Departments by the Elderly Population When Continuing Care Is Not Well Established. PLoS One 2016; 11:e0165939. [PMID: 27973563 PMCID: PMC5156362 DOI: 10.1371/journal.pone.0165939] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 10/20/2016] [Indexed: 11/18/2022] Open
Abstract
Introduction The elderly, who suffer from multiple chronic diseases, represent a substantial proportion of Emergency Department (ED) frequent users, thus contributing to ED overcrowding, although they could benefit from other health care facilities, if those were available. The aim of this study was to evaluate and characterize hospital visits of older patients (age 65 or greater) to the ED of a university teaching hospital in Rome from the 1st of January to the 31st of December 2014, in order to identify clinical and social characteristics potentially associated with “elderly frequent users”. Material and Methods A retrospective study was performed during the calendar year 2014 (1st January 2014 – 31st December 2014) analyzing all ED admissions to the University Hospital of Rome Tor Vergata. Variables collected included age, triage code, arrival data, discharge diagnosis, and visit outcome. We performed a risk analysis using univariate binary logistic regression models. Results A total number of 38,016 patients accessed the ED, generating 46,820 accesses during the study period, with an average of 1.23 accesses for patient. The elderly population represented a quarter of the total ED population and had an increased risk of frequent use (OR 1.5: CI 1.4–1.7) and hospitalization (OR 3.8: CI 3.7–4). Moreover, they showed a greater diagnostic complexity, as demonstrated by the higher incidence of yellow and red priority codes compared to other ED populations (OR 3.1: CI 2.9–3.2). Discussion Older patients presented clinical and social characteristics related to the definition of “elderly frail frequent users”. The fact that a larger number of hospitalizations occurred in such patients is indirect evidence of frailty in this specific population, suggesting that hospital admissions may be an inappropriate response to frailty, especially when continued care is not established. Conclusion Enhancement of continuity of care, establishment of a tracking system for those who are at greater risk of visiting the ED and evaluating fragile individuals should be the highest priority in addressing ED frequent usage by the elderly.
Collapse
Affiliation(s)
- Jacopo M. Legramante
- Department of Medical Systems, University of Rome Tor Vergata, Foundation Policlinico Tor Vergata, Rome, Italy
- Emergengy Department, Foundation Policlinico Tor Vergata, Rome, Italy
| | - Laura Morciano
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Francesca Lucaroni
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Francesco Gilardi
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Emanuele Caredda
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Alessia Pesaresi
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Massimo Coscia
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Stefano Orlando
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Antonella Brandi
- Emergengy Department, Foundation Policlinico Tor Vergata, Rome, Italy
| | | | - Vito N. Di Lecce
- Emergengy Department, Foundation Policlinico Tor Vergata, Rome, Italy
| | | | - Leonardo Palombi
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
- * E-mail:
| |
Collapse
|
37
|
Grover CA, Crawford E, Close RJ. The Efficacy of Case Management on Emergency Department Frequent Users: An Eight-Year Observational Study. J Emerg Med 2016; 51:595-604. [DOI: 10.1016/j.jemermed.2016.06.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 09/16/2015] [Accepted: 06/02/2016] [Indexed: 11/26/2022]
|
38
|
Christensen EW, Kharbanda AB, Velden HV, Payne NR. Predicting Frequent Emergency Department Use by Pediatric Medicaid Patients. Popul Health Manag 2016; 20:208-215. [PMID: 27564725 DOI: 10.1089/pop.2016.0051] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The objective of this study was to determine the patient characteristics and health care utilization patterns that predict frequent emergency department (ED) use (≥4 visits per year) over time to assist health care organizations in targeting patients for care management. This was a retrospective, population-based study of 13,265 Medicaid children aged 0-20 years who were attributed to a single pediatric accountable care organization for at least 2 consecutive years between June 2012 and May 2015. Year-to-year persistence as a frequent ED user was 36.3% (95% confidence interval [CI]: 33.4 to 38.4), which does not support the notion that once a frequent user, always a frequent user. Hence, interventions to reduce frequent ED use may appear to be effective when ED use would have regressed toward the mean without any intervention. At an individual patient level, predictability of frequent ED use was 0.437 (95% CI: 0.358 to 0.485) across frequent ED users of all ages compared with 0.723 (95% CI: 0.435 to 0.824) for those aged <1 year. Accordingly, this latter group may be a better target for interventions than frequent ED users generally.
Collapse
Affiliation(s)
- Eric W Christensen
- 1 Department of Research and Sponsored Programs, Children's Hospitals and Clinics of Minnesota , Minneapolis, Minnesota
| | - Anupam B Kharbanda
- 2 Department of Critical Care and Emergency Medicine, Children's Hospitals and Clinics of Minnesota , Minneapolis, Minnesota
| | - Heidi Vander Velden
- 1 Department of Research and Sponsored Programs, Children's Hospitals and Clinics of Minnesota , Minneapolis, Minnesota
| | - Nathaniel R Payne
- 1 Department of Research and Sponsored Programs, Children's Hospitals and Clinics of Minnesota , Minneapolis, Minnesota
| |
Collapse
|
39
|
Singhal A, Tien YY, Hsia RY. Racial-Ethnic Disparities in Opioid Prescriptions at Emergency Department Visits for Conditions Commonly Associated with Prescription Drug Abuse. PLoS One 2016; 11:e0159224. [PMID: 27501459 PMCID: PMC4976905 DOI: 10.1371/journal.pone.0159224] [Citation(s) in RCA: 180] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 06/29/2016] [Indexed: 11/18/2022] Open
Abstract
Prescription drug abuse is a growing problem nationally. In an effort to curb this problem, emergency physicians might rely on subjective cues such as race-ethnicity, often unknowingly, when prescribing opioids for pain-related complaints, especially for conditions that are often associated with drug-seeking behavior. Previous studies that examined racial-ethnic disparities in opioid dispensing at emergency departments (EDs) did not differentiate between prescriptions at discharge and drug administration in the ED. We examined racial-ethnic disparities in opioid prescription at ED visits for pain-related complaints often associated with drug-seeking behavior and contrasted them with conditions objectively associated with pain. We hypothesized a priori that racial-ethnic disparities will be present among opioid prescriptions for conditions associated with non-medical use, but not for objective pain-related conditions. Using data from the National Hospital Ambulatory Medical Care Survey for 5 years (2007-2011), the odds of opioid prescription during ED visits made by non-elderly adults aged 18-65 for 'non-definitive' conditions (toothache, back pain and abdominal pain) or 'definitive' conditions (long-bone fracture and kidney stones) were modeled. Opioid prescription at discharge and opioid administration at the ED were the primary outcomes. We found significant racial-ethnic disparities, with non-Hispanic Blacks being less likely (adjusted odds ratio ranging from 0.56-0.67, p-value < 0.05) to receive opioid prescription at discharge during ED visits for back pain and abdominal pain, but not for toothache, fractures and kidney stones, compared to non-Hispanic whites after adjusting for other covariates. Differential prescription of opioids by race-ethnicity could lead to widening of existing disparities in health, and may have implications for disproportionate burden of opioid abuse among whites. The findings have important implications for medical provider education to include sensitization exercises towards their inherent biases, to enable them to consciously avoid these biases from defining their practice behavior.
Collapse
Affiliation(s)
- Astha Singhal
- Health Policy and Health Services Research, Boston University School of Dental Medicine, Boston, Massachusetts, United States of America
| | - Yu-Yu Tien
- University of Iowa College of Pharmacy, Iowa City, Iowa, United States of America
| | - Renee Y. Hsia
- Department of Emergency Medicine and Philip R. Lee Institute for Health Policy Studies, University of California at San Francisco, San Francisco, California, United States of America
- * E-mail:
| |
Collapse
|
40
|
Soril LJ, Leggett LE, Lorenzetti DL, Noseworthy TW, Clement FM. Characteristics of frequent users of the emergency department in the general adult population: A systematic review of international healthcare systems. Health Policy 2016; 120:452-61. [DOI: 10.1016/j.healthpol.2016.02.006] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Revised: 01/25/2016] [Accepted: 02/09/2016] [Indexed: 10/22/2022]
|
41
|
Lippi G, Buonocore R, Picanza A, Schirosa F, Cervellin G. Red blood cell distribution width and haemoglobin are associated with hospital admission in patients with acute allergic reactions. Br J Biomed Sci 2016; 73:21-4. [PMID: 27182672 DOI: 10.1080/09674845.2016.1140382] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Red blood cell distribution width (RDW) is significantly associated with a variety of human disorders. This study aimed to investigate whether RDW value at admission may predict the need of hospitalisation in patients presenting to the emergency department (ED) with acute allergic reactions. MATERIALS AND METHODS The study population consisted of adult patients (aged > 17) admitted to the ED for acute allergic reactions. RESULTS One hundred and thirty-two subjects were included, 12 of whom (9%) required hospital admission for severity of symptoms. Patients who needed hospital admission displayed significantly lower values of haemoglobin and significantly higher values of RDW-coefficient of variation (RDW-CV). In multivariate analysis, haemoglobin and RDW-CV were found to be independent predictors of hospital admission. The area under the curve (AUC), sensitivity and specificity for predicting hospital admission were 0.72, 0.88 and 0.42 for haemoglobin and 0.73, 0.88 and 0.50 for RDW-CV, respectively. The combination of these tests (both positive) was characterised by 0.76 AUC, 0.83 sensitivity, 0.67 specificity, 0.96 negative predictive value and 0.30 positive predictive. DISCUSSION The results of this study suggest that two common and inexpensive parameters such as haemoglobin and RDW are independent predictors of hospital admission in patients presenting to the ED with acute allergic reactions.
Collapse
Affiliation(s)
- Giuseppe Lippi
- a Section of Clinical Biochemistry , University of Verona , Verona , Italy
| | - Ruggero Buonocore
- b Laboratory of Clinical Chemistry and Hematology, Academic Hospital of Parma , Parma , Italy
| | - Alessandra Picanza
- b Laboratory of Clinical Chemistry and Hematology, Academic Hospital of Parma , Parma , Italy
| | - Fabio Schirosa
- c Emergency Department, Academic Hospital of Parma , Parma , Italy
| | | |
Collapse
|
42
|
Bodenmann P, Baggio S, Iglesias K, Althaus F, Velonaki VS, Stucki S, Ansermet C, Paroz S, Trueb L, Hugli O, Griffin JL, Daeppen JB. Characterizing the vulnerability of frequent emergency department users by applying a conceptual framework: a controlled, cross-sectional study. Int J Equity Health 2015; 14:146. [PMID: 26645272 PMCID: PMC4673736 DOI: 10.1186/s12939-015-0277-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 12/02/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Frequent emergency department (ED) users meet several of the criteria of vulnerability, but this needs to be further examined taking into consideration all vulnerability's different dimensions. This study aimed to characterize frequent ED users and to define risk factors of frequent ED use within a universal health care coverage system, applying a conceptual framework of vulnerability. METHODS A controlled, cross-sectional study comparing frequent ED users to a control group of non-frequent users was conducted at the Lausanne University Hospital, Switzerland. Frequent users were defined as patients with five or more visits to the ED in the previous 12 months. The two groups were compared using validated scales for each one of the five dimensions of an innovative conceptual framework: socio-demographic characteristics; somatic, mental, and risk-behavior indicators; and use of health care services. Independent t-tests, Wilcoxon rank-sum tests, Pearson's Chi-squared test and Fisher's exact test were used for the comparison. To examine the -related to vulnerability- risk factors for being a frequent ED user, univariate and multivariate logistic regression models were used. RESULTS We compared 226 frequent users and 173 controls. Frequent users had more vulnerabilities in all five dimensions of the conceptual framework. They were younger, and more often immigrants from low/middle-income countries or unemployed, had more somatic and psychiatric comorbidities, were more often tobacco users, and had more primary care physician (PCP) visits. The most significant frequent ED use risk factors were a history of more than three hospital admissions in the previous 12 months (adj OR:23.2, 95%CI = 9.1-59.2), the absence of a PCP (adj OR:8.4, 95%CI = 2.1-32.7), living less than 5 km from an ED (adj OR:4.4, 95%CI = 2.1-9.0), and household income lower than USD 2,800/month (adj OR:4.3, 95%CI = 2.0-9.2). CONCLUSIONS Frequent ED users within a universal health coverage system form a highly vulnerable population, when taking into account all five dimensions of a conceptual framework of vulnerability. The predictive factors identified could be useful in the early detection of future frequent users, in order to address their specific needs and decrease vulnerability, a key priority for health care policy makers. Application of the conceptual framework in future research is warranted.
Collapse
Affiliation(s)
- Patrick Bodenmann
- Vulnerable Populations Center, Department of Ambulatory Care and Community Medicine, University of Lausanne & Lausanne University Hospital, Lausanne, CH-1015, Switzerland.
| | - Stéphanie Baggio
- Life Course and Inequality Research Center, Faculty of Social and Political Sciences, University of Lausanne, Lausanne, CH-1015, Switzerland.
| | - Katia Iglesias
- Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, CH-1011, Switzerland.
| | - Fabrice Althaus
- Vulnerable Populations Center, Department of Ambulatory Care and Community Medicine, University of Lausanne & Lausanne University Hospital, Lausanne, CH-1015, Switzerland.
| | - Venetia-Sofia Velonaki
- Institute of Higher Education and Research in Healthcare, Lausanne University Hospital, Lausanne, CH-1010, Switzerland.
| | - Stephanie Stucki
- Addiction Switzerland, Research Institute, Lausanne, CH-1001, Switzerland.
| | - Corine Ansermet
- Department of Community Medicine and Public Health, Lausanne University Hospital, Lausanne, CH-1011, Switzerland.
| | - Sophie Paroz
- Department of Community Medicine and Public Health, Lausanne University Hospital, Lausanne, CH-1011, Switzerland.
| | - Lionel Trueb
- Emergency Department, Lausanne University Hospital, Lausanne, CH-1011, Switzerland.
| | - Olivier Hugli
- Emergency Department, Lausanne University Hospital, Lausanne, CH-1011, Switzerland.
| | - Judith L Griffin
- Vulnerable Populations Center, Department of Ambulatory Care and Community Medicine, University of Lausanne & Lausanne University Hospital, Lausanne, CH-1015, Switzerland.
| | - Jean-Bernard Daeppen
- Alcohol Treatment Service, Lausanne University Hospital, Lausanne, CH-1011, Switzerland.
| |
Collapse
|
43
|
Solberg RG, Edwards BL, Chidester JP, Perina DG, Brady WJ, Williams MD. The prehospital and hospital costs of emergency care for frequent ED patients. Am J Emerg Med 2015; 34:459-63. [PMID: 26763824 DOI: 10.1016/j.ajem.2015.11.066] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Revised: 11/23/2015] [Accepted: 11/24/2015] [Indexed: 10/22/2022] Open
Abstract
INTRODUCTION Frequent emergency department (ED) use has been identified as a cause of ED overcrowding and increasing health care costs. Studies have examined the expense of frequent patients (FPs) to hospitals but have not added the cost Emergency Medical Services (EMS) to estimate the total cost of this pattern of care. METHODS Data on 2012 ED visits to a rural Level I Trauma Center and public safety net hospital were collected through a deidentified patient database. Transport data and 2012 Medicare Reimbursement Schedules were used to estimate the cost of EMS transport. Health information, outcomes, and costs were compared to find differences between the FP and non-FP group. RESULTS This study identified 1242 FPs who visited the ED 5 or more times in 2012. Frequent patients comprised 3.25% of ED patients but accounted for 17% of ED visits and 13.7% of hospital costs. Frequent patients had higher rates of chronic disease, severity scores, and mortality. Frequent patients arrived more often via ambulance and accounted for 32% of total transports at an estimated cost of $2.5-$3.2 million. Hospital costs attributable to FPs were $29.1 million, bringing the total cost of emergency care to $31.6-$32.3 million, approximately $25,000 per patient. CONCLUSIONS This study demonstrates that the inclusion of a prehospital cost estimate adds approximately 10% to the cost of care for the FP population. In addition to improving care for a sick population of patients, programs that reduce frequent EMS and ED use have the potential to produce a favorable cost benefit to communities and health systems.
Collapse
|
44
|
Choi NG, Marti CNN, DiNitto DM, Choi BY. Alcohol Use as Risk Factors for Older Adults' Emergency Department Visits: A Latent Class Analysis. West J Emerg Med 2015; 16:1146-58. [PMID: 26759670 PMCID: PMC4703192 DOI: 10.5811/westjem.2015.9.27704] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Revised: 09/21/2015] [Accepted: 09/23/2015] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Late middle-aged and older adults' share of emergency department (ED) visits is increasing more than other age groups. ED visits by individuals with substance-related problems are also increasing. This paper was intended to identify subgroups of individuals aged 50+ by their risk for ED visits by examining their health/mental health status and alcohol use patterns. METHODS Data came from the 2013 National Health Interview Survey's Sample Adult file (n=15,713). Following descriptive analysis of sample characteristics by alcohol use patterns, latent class analysis (LCA) modeling was fit using alcohol use pattern (lifetime abstainers, ex-drinkers, current infrequent/light/moderate drinkers, and current heavy drinkers), chronic health and mental health status, and past-year ED visits as indicators. RESULTS LCA identified a four-class model. All members of Class 1 (35% of the sample; lowest-risk group) were infrequent/light/moderate drinkers and exhibited the lowest probabilities of chronic health/mental health problems; Class 2 (21%; low-risk group) consisted entirely of lifetime abstainers and, despite being the oldest group, exhibited low probabilities of health/mental health problems; Class 3 (37%; moderate-risk group) was evenly divided between ex-drinkers and heavy drinkers; and Class 4 (7%; high-risk group) included all four groups of drinkers but more ex-drinkers. In addition, Class 4 had the highest probabilities of chronic health/mental problems, unhealthy behaviors, and repeat ED visits, with the highest proportion of Blacks and the lowest proportions of college graduates and employed persons, indicating significant roles of these risk factors. CONCLUSION Alcohol nonuse/use (and quantity of use) and chronic health conditions are significant contributors to varying levels of ED visit risk. Clinicians need to help heavy-drinking older adults reduce unhealthy alcohol consumption and help both heavy drinkers and ex-drinkers improve chronic illnesses self-management.
Collapse
Affiliation(s)
- Namkee G. Choi
- The University of Texas at Austin, School of Social Work, Austin, Texas
| | | | - Diana M. DiNitto
- The University of Texas at Austin, School of Social Work, Austin, Texas
| | - Bryan Y. Choi
- Brown University, Department of Emergency Medicine, Providence, Rhode Island
| |
Collapse
|