Background
Methods
Scoping review
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Which factors are predictive of frequent emergency department use?
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Which factors predict chronic frequent emergency department use over a multiple-year period?
Results
Study designs and definitions (Table 1)
Reference | Authors | Year of publication | Study period | Country | Study design | Population | Sample size | Definition |
---|---|---|---|---|---|---|---|---|
[7] | Andrén et al. | 1987 | 3 years (October 1979 through October 1982) | Sweden | Prospective cohort study | Cohort of frequent users of the St Göran’s Hospital ED | 232 | 4 or more visits to the ED during the index year |
[38] | Rask et al. | 1998 | 24 months (1992–1994) | USA | Cohort observational study | Random sample of adults visiting a public hospital in Atlanta, Georgia | 351 | More than 10 ED visits during the 2-year follow-up period |
[30] | Mandelberg et al. | 2000 | 5 years (July 1 1993 to June 30 1998) | USA | Cross-sectional and retrospective cohort study | Database of all 348 858 visits made to the San Francisco General Hospital ED during the study period | 43,383 | 5 or more visits in a 12 month period |
[5] | Hansagi et al. | 2001 | 1 year (January 1 to December 31 1996) | Sweden | Retrospective database study | Frequent and infrequent users who visited the Huddinge Hospital ED during the study period | 47,349 | 4 or more visits per year |
[39] | Okuyemi et al. | 2001 | 3 years (July 1 1993 to June 30 1996) | USA | Retrospective database review | Frequent and infrequent ED users of a university hospital | 12,258; 13,387; 13,219 | 3 or more visits per year |
[10] | Huang et al. | 2003 | 1 year (October 1 2000 to September 30 2001) | Taiwan | Retrospective study (telephone interviews) | Frequent and infrequent ED users randomly selected in a medical center | 800 | 4 or more visits per year |
[8] | Sun et al. | 2003 | 5 months (February through June 1995) | USA | Cross-sectional multicenter ED survey | Adult patients who came to the ED with selected problems | 2333 | 4 or more self-reported prior ED visits |
[23] | Ruger et al. | 2004 | 1 year (January 1 2001-December 31 2001) | USA | Retrospective cross-sectional study | All ED visits to an urban academic hospital | 71,941 | Group 1: one ED visit in 2001, group 2: two visits, group 3: three to five visits, group 4: six to 20 visits, and group 5: more than 20 visit |
[40] | Zuckerman et al. | 2004 | 2 years (1997 and 1999) | USA | National Survey data review | 1997 and 1999 National Survey of America’s Families | 89,626 | 3 or more visits per year |
[41] | Freitag et al. | 2005 | 1 year | USA | Data from 2 randomized controlled trials | Patients with chronic daily headache (>15 headache days per month) with at least one ED visit | 785 | 3 to 6 ED visits per year |
[3] | Griswold et al. | 2005 | 6 years (1996 to 2001) | USA | Data from four prospective cohort studies | Adults presenting with acute asthma to 83 US EDs | 3151 | 6 or more ED visits per year |
[4] | Hunt et al. | 2006 | 1 year (July 2000 through June 2001) | USA | Population-based Community Tracking Study Household Survey | Households in 60 randomly selected communities and in a national supplemental sample | 49,603 | 4 or more visits in a single year |
[33] | Pines et al. | 2006 | 3 months (July through September 2004) | USA | Retrospective cohort study | Asthmatics in Southeastern Pennsylvania | 1799 | 3 or more visits in a 12 month period |
[42] | Moore et al. | 2007 | 24 months (January 1 2003 through December 31 2004) | Australia | Retrospective cohort study | All patients who attended the ED during the study period | 40,942 | Re-presentation to the ED within 28 days of discharge |
[9] | Friedman et al. | 2009 | 3 years (2004–2006) | USA | Longitudinal population-based survey | Randomly selected severe headache sufferers | 13,451 | 4 or more ED visits for headhache treatment in the previous 12 months |
[37] | Paul et al. | 2010 | 3 years (January 1 2005 through December 31 2007) | Singapore | Retrospective database review | Patients who attended the ED from 1 January-31 December 2006 without prior attendance during the 12 months were tracked for 12 months | 82,172 | 5 or more visits to an ED during the last 12 months |
[6] | Bieler et al. | 2012 | 1 year (April 2008-March 2009) | Switzerland | Retrospective chart review case-control | Randomized samples of frequent and nonfrequent users of the Lausanne University Hospital | 719 | 4 or more visits to an ED during the last 12 months |
[27] | Doupe et al. | 2012 | 1 year (Fiscal year 2004–2005) | Canada | Retrospective health record review | All Manitobans with at least 1 ED visit in the Winnipeg Health Region | 105,687 | 7 to 17 ED visits per year |
[36] | Billings et al. | 2013 | 6 years (2004–2009) | USA | Prospective predictive modeling | Medicaid ED users in New York City | 205,139 | Multiple subgroups (see article) |
[11] | Palmer et al. | 2014 | 1 year (2009) | Canada | Retrospective database review | All ED visits during 1 calendar year to an urban regional hospital, an urban urgent care centre and a rural community hospital | 59,803 | 4 or more visits to an ED in a year |
Characteristics of frequent ED use (Table 2)
Gender
Predictive factors | Details | References |
---|---|---|
Demographic | ||
Male | ||
Female | [11] | |
Age | 75 years and older | |
Between 30 and 59 years old | [30] | |
Lower age | [41] | |
Location | Attendance at a rural ED | [11] |
Urban area (Philadelphia County) | [33] | |
Core area patients (Winnipeg Health Region) | [27] | |
Distance to ED | Less than 10 km | [6] |
More than 2 km | [37] | |
Socioeconomic | ||
Education | No high school diploma | [40] |
High school education (or less) | ||
Family status | Single parents | |
Single | [8] | |
Divorced | [8] | |
Being under guardianship | [6] | |
Number of children living in the house | [33] | |
Housing status | Homeless | |
Income | Living in lowest income areas | [27] |
Being unemployed or dependant of government welfare | [6] | |
Receiving government pension | [42] | |
Family income below the poverty threshold | [4] | |
Low socioeconomic status | [9] | |
Low income groups | [40] | |
Income of less than 10 000$ | [8] | |
Insurance | Being uninsured | |
Medicaid | ||
Medicare coverage | ||
Publicly insured | ||
Medical Assistance | [33] | |
Medi-Cal sponsored | [30] | |
Current healthcare use | Multiple visits to a specialist physician | |
Multiple visits to a primary care provider | ||
Calling a health helpline | [27] | |
Being hospitalized | ||
Outpatient visits | ||
Visiting a clinic | ||
History of past emergency department use | ||
Identifying an ED or hospital clinic as primary care site | [8] | |
Prescription medication use | ||
Access to primary healthcare services | Having a primary care provider | |
ED as primary source of care | ||
Having another regular source of care | [10] | |
Medical | ||
Mental illness | Substance abuse problems | |
Mental disorder | ||
Physical disease | ||
Chronic condition | ||
Exacerbation of chronic conditions | Sickle cell anemia, renal failure, chronic obstructive pulmonary disease | [30] |
Fair/poor physical health | ||
Other diseases | Pulmonary disease | |
Cardiovascular disease | [10] | |
Gastrointestinal disease | [10] | |
Cancer | [10] | |
Medical scores | Severe rating on MIDAS | |
Lower role physical domain | [41] | |
Higher DRG severity score | [23] |
Age
Location
Education and socioeconomic factors
Factors associated with current healthcare use
Medical factors
Characteristics of chronic frequent ED use (Table 3)
Reference | Authors | Definition of chronic use | Prevalence % of patients (% of total ED visits) | Predictive factors |
---|---|---|---|---|
[7] | Andrén et al. | 4 or more ED visits per year over a 3 year period | Year 1 : 31 % Year 2 : 19 % | Previous ED visits, contact with psychiatric care, living alone and perceived loneliness |
[36] | Billings et al. | 5 or more ED visits per year over a 3 year period | 1.2 % (10,9 %) | 77,9 % had higher levels of chronic illnesses 58,8 % had a history of substance abuse 72,3 % had a history of mental illness48, 9 % had a history of both substance abuse and mental illnessa |
5 or more ED visits per year over a 5 year period | 0.8 % (8,4 %) | |||
3 or more ED visits per year over a 3 year period | 3.5 % (19,2 %) | |||
3 or more ED visits per year over a 5 year period | 1.7 % (12,1 %) | |||
[38] | Rask et al. | More than 10 subsequent ED visits (2 year period) | 16,6 % (65,5 %) | At least one hospitalization and at least one primary care visit |
[39] | Okuyemi et al. | 3 or more ED visits per year over a 3 year period | 9 to 11 % (between 25 and 30 %) | Being a frequent ED user during the previous year is an independent predictor of frequency of use during the following year |