Identifying subgroups and risk among frequent emergency department users in British Columbia
Abstract Objective: Frequent emergency department (ED) users are heterogeneous. We aimed to identify subgroups and assess their mortality. Methods: We identified patients ≥18 years with ≥1 ED visit in British Columbia from April 1, 2012 to March 31, 2015, and linked to hospitalization, physician bil...
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| Format: | Article |
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Elsevier
2021-02-01
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| Series: | Journal of the American College of Emergency Physicians Open |
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| Online Access: | https://doi.org/10.1002/emp2.12346 |
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| author | Jessica Moe Fiona O'Sullivan Margaret J. McGregor Michael J. Schull Kathryn Dong Brian R. Holroyd Eric Grafstein Corinne M. Hohl Johanna Trimble Kimberlyn M. McGrail |
| author_facet | Jessica Moe Fiona O'Sullivan Margaret J. McGregor Michael J. Schull Kathryn Dong Brian R. Holroyd Eric Grafstein Corinne M. Hohl Johanna Trimble Kimberlyn M. McGrail |
| author_sort | Jessica Moe |
| collection | DOAJ |
| description | Abstract Objective: Frequent emergency department (ED) users are heterogeneous. We aimed to identify subgroups and assess their mortality. Methods: We identified patients ≥18 years with ≥1 ED visit in British Columbia from April 1, 2012 to March 31, 2015, and linked to hospitalization, physician billing, prescription, and mortality data. Frequent users were the top 10% of patients by ED visits. We employed cluster analysis to identify frequent user subgroups. We assessed 365‐day mortality using Kaplan‐Meier curves and conducted Cox regressions to assess mortality risk factors within subgroups. Results: We identified 4 subgroups. Subgroup 1 (“Elderly”) had median age 77 years (interquartile range [IQR]: 66–85), 5 visits/year (IQR: 4–6), median 8 prescription medications (IQR: 5–11), and 24.7% mortality. Subgroup 2 (“Mental Health and Alcohol Use”) had median age 48 years (IQR: 34–61), 13 visits/year (IQR: 10–16), and 12.3% mortality. They made a median 31 general practitioner visits (IQR: 19–51); however, only 23.7% received a majority of services from 1 primary care physician. Subgroup 3 (“Young Mental Health”) had median age 39 years (IQR: 28–51), 5 visits/year (IQR: 4–6), and 2.2% mortality. Subgroup 4 (“Short‐term”) had median age 50 years (IQR: 34–65), 4 visits/year (IQR: 4–5) regularly spaced over a short term, and 1.4% mortality. Male sex (all subgroups), long‐term care (“Mental Health and Alcohol Use;” “Young Mental Health”), and rural residence (“Elderly” in long‐term care; “Young Mental Health”) were associated with increased mortality. Conclusions: Our results identify frequent user subgroups with varying mortality. Future research should explore subgroups’ unmet needs and tailor interventions toward them. |
| format | Article |
| id | doaj-art-7d2592e6c38f48e0a8d6b3b9bd0ae659 |
| institution | DOAJ |
| issn | 2688-1152 |
| language | English |
| publishDate | 2021-02-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of the American College of Emergency Physicians Open |
| spelling | doaj-art-7d2592e6c38f48e0a8d6b3b9bd0ae6592025-08-20T03:03:51ZengElsevierJournal of the American College of Emergency Physicians Open2688-11522021-02-0121n/an/a10.1002/emp2.12346Identifying subgroups and risk among frequent emergency department users in British ColumbiaJessica Moe0Fiona O'Sullivan1Margaret J. McGregor2Michael J. Schull3Kathryn Dong4Brian R. Holroyd5Eric Grafstein6Corinne M. Hohl7Johanna Trimble8Kimberlyn M. McGrail9Department of Emergency Medicine, University of British Columbia Department of Emergency Medicine, Vancouver General Hospital Vancouver British Columbia CanadaDepartment of Emergency Medicine University of British Columbia Vancouver British Columbia CanadaDepartment of Family Practice University of British Columbia Vancouver British Columbia CanadaInstitute for Clinical Evaluative Sciences Department of Medicine University of Toronto Toronto Ontario CanadaDepartment of Emergency Medicine University of Alberta Edmonton Alberta CanadaDepartment of Emergency Medicine Emergency Strategic Clinical Networ, Alberta Health Services University of Alberta Edmonton Alberta CanadaDepartment of Emergency Medicine University of British Columbia Vancouver British Columbia CanadaDepartment of Emergency Medicine, University of British Columbia Department of Emergency Medicine, Vancouver General Hospital Vancouver British Columbia CanadaPatients for Patient Safety Canada Roberts Creek Vancouver British Columbia CanadaPopulation Data BC School of Population and Public Health, University of British Columbia Vancouver British Columbia CanadaAbstract Objective: Frequent emergency department (ED) users are heterogeneous. We aimed to identify subgroups and assess their mortality. Methods: We identified patients ≥18 years with ≥1 ED visit in British Columbia from April 1, 2012 to March 31, 2015, and linked to hospitalization, physician billing, prescription, and mortality data. Frequent users were the top 10% of patients by ED visits. We employed cluster analysis to identify frequent user subgroups. We assessed 365‐day mortality using Kaplan‐Meier curves and conducted Cox regressions to assess mortality risk factors within subgroups. Results: We identified 4 subgroups. Subgroup 1 (“Elderly”) had median age 77 years (interquartile range [IQR]: 66–85), 5 visits/year (IQR: 4–6), median 8 prescription medications (IQR: 5–11), and 24.7% mortality. Subgroup 2 (“Mental Health and Alcohol Use”) had median age 48 years (IQR: 34–61), 13 visits/year (IQR: 10–16), and 12.3% mortality. They made a median 31 general practitioner visits (IQR: 19–51); however, only 23.7% received a majority of services from 1 primary care physician. Subgroup 3 (“Young Mental Health”) had median age 39 years (IQR: 28–51), 5 visits/year (IQR: 4–6), and 2.2% mortality. Subgroup 4 (“Short‐term”) had median age 50 years (IQR: 34–65), 4 visits/year (IQR: 4–5) regularly spaced over a short term, and 1.4% mortality. Male sex (all subgroups), long‐term care (“Mental Health and Alcohol Use;” “Young Mental Health”), and rural residence (“Elderly” in long‐term care; “Young Mental Health”) were associated with increased mortality. Conclusions: Our results identify frequent user subgroups with varying mortality. Future research should explore subgroups’ unmet needs and tailor interventions toward them.https://doi.org/10.1002/emp2.12346cluster analysisemergency medicineepidemiologyfrequent usershealth policyhigh service users |
| spellingShingle | Jessica Moe Fiona O'Sullivan Margaret J. McGregor Michael J. Schull Kathryn Dong Brian R. Holroyd Eric Grafstein Corinne M. Hohl Johanna Trimble Kimberlyn M. McGrail Identifying subgroups and risk among frequent emergency department users in British Columbia Journal of the American College of Emergency Physicians Open cluster analysis emergency medicine epidemiology frequent users health policy high service users |
| title | Identifying subgroups and risk among frequent emergency department users in British Columbia |
| title_full | Identifying subgroups and risk among frequent emergency department users in British Columbia |
| title_fullStr | Identifying subgroups and risk among frequent emergency department users in British Columbia |
| title_full_unstemmed | Identifying subgroups and risk among frequent emergency department users in British Columbia |
| title_short | Identifying subgroups and risk among frequent emergency department users in British Columbia |
| title_sort | identifying subgroups and risk among frequent emergency department users in british columbia |
| topic | cluster analysis emergency medicine epidemiology frequent users health policy high service users |
| url | https://doi.org/10.1002/emp2.12346 |
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