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Characteristics of frequent users of emergency departments in Alberta and Ontario, Canada: an administrative data study

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Canadian Journal of Emergency Medicine Aims and scope Submit manuscript

Abstract

Objective

Frequent users to emergency departments (EDs) are a diverse group of patients accounting for a disproportionate number of ED presentations. This study examined sociodemographic and ED visit characteristics of adult high-system users in two Canadian provinces.

Methods

Cohorts of high-system users were created for Alberta and Ontario including patients with the top 10% of presentations in the National Ambulatory Care Reporting System (April 2015–March 2016). Controls were random samples of non-high-system user patients. Sociodemographic and ED visits data were used to predict high-system user group membership in a multivariable logistic regression model.

Results

There were 579,674 high-system users and 2,115,960 controls. High-system users were more likely to be female [odds ratio (OR) = 1.1, 95% confidence interval (CI) 1.1,1.1], older (OR 1.02 per 5 years, 95% CI 1.02,1.02), from the lowest-income quintile (OR 1.8, 95% CI 1.7,1.8), and more rural (OR 1.6, 95% CI 1.6,1.6) than controls. High-system users had a higher proportion of presentations by ambulance (OR 1.1 per 0.25 increase, 95% CI 1.1,1.1) and disposition was admission/transfer (OR 1.1 per 0.25 increase, 95% CI 1.1,1.1), left without being seen (OR 1.1, 95% CI 1.1,1.1), or left against medical advice (OR 1.1, 95% CI 1.1,1.1) more often than controls.

Conclusion

High-system users were more likely to be female, older, live in rural areas and within the lowest-income quintile compared to controls. Their heterogeneity in acuity, comorbid chronic diseases, and limited access to primary care suggests that interventions referring high-system users to primary care may be fruitful in reducing ED utilization by high-system users.

Résumé

Objectif

Les utilisateurs fréquents des services d'urgence sont un groupe diversifié de patients qui représentent un nombre disproportionné de présentations aux services d'urgence. Cette étude a examiné les caractéristiques sociodémographiques et les visites aux urgences de grands utilisateurs adultes du système de santé dans deux provinces canadiennes.

Méthode

Des cohortes de grands utilisateurs du système de santé ont été créées pour l'Alberta et l'Ontario, y compris les patients ayant fait l'objet des 10 % de présentations les plus importantes dans le système national d'information sur les soins ambulatoires (avril 2015-mars 2016). Les contrôles étaient des échantillons aléatoires des patients ne faisant pas partie des grands utilisateurs. Les données sociodémographiques et les données sur les visites aux urgences ont été utilisées pour prédire l'appartenance à un groupe de grands utilisateurs du système dans un modèle de régression logistique multivariable.

Résultats

Il y avait 579 674 de grands utilisateurs et 2 115 960 témoins. Les grands utilisateurs de système étaient plus susceptibles d'être des femmes (rapport des cotes [RC] = 1,1, intervalle de confiance à 95 % (IC) 1,1, 1,1), plus âgés (RC = 1,02 tous les 5 ans, IC à 95 % 1,02, 1,02), d'après quintile de revenu le plus bas (RC = 1,8, IC à 95 % 1,7,1,8), et plus rural (RC = 1,6, IC à 95 % 1,6,1,6) que les témoins. Les grands utilisateurs du système avaient une proportion plus élevée de présentations par ambulance (RC = 1,1 pour une augmentation de 0,25, IC à 95 % 1,1, 1,1) et la disposition était l'admission / transfert (RC = 1,1 pour une augmentation de 0,25, IC à 95 % 1,1, 1,1), parti sans être vu (OR = 1,1, IC à 95% 1,1, 1,1), ou parti contre l'avis médical (OR = 1,1, IC à 95 % 1,1, 1,1) plus souvent que les témoins.

Conclusions

Les grands utilisateurs du système étaient plus susceptibles d'être des femmes, des personnes âgées, vivant dans des zones rurales et se situant dans le quintile de revenu le plus bas, par rapport aux témoins. Leur hétérogénéité en termes d'acuité, de comorbidité des maladies chroniques et d'accès limité aux soins primaires suggère que les interventions qui orientent les grands utilisateurs du haut système vers les soins primaires peuvent être fructueuses pour réduire l'utilisation des urgences par les grands utilisateurs du système

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Acknowledgements

The authors thank Prof. Howard Ovens MD from the University of Toronto for helping to secure grant funding and for insightful comments. The authors thank the Canadian Institute for Health Information for providing health datasets. Parts of this material are based on data and information provided by the Canadian Institute for Health Information. However, the analyses, conclusions, opinions and statements expressed herein are those of the author and not those of the Canadian Institute for Health Information.

Funding

This study was supported by a grant from the Canadian Institutes of Health Research (#394223). The funding source had no direct involvement in the study design, analysis, interpretation or decision to submit this work.

Author information

Authors and Affiliations

  1. Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, 524 Edmonton Clinic Health Academy, Edmonton, AB, T6G 1C9, Canada

    Anqi Chen & Rhonda J. Rosychuk

  2. Department of Obstetrics and Gynecology, University of Alberta, Edmonton, AB, Canada

    Maria Ospina

  3. School of Public Health, University of Alberta, Edmonton, AB, Canada

    Maria Ospina

  4. Department of Emergency Medicine, University of Calgary, Calgary, AB, Canada

    Andrew McRae

  5. Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada

    Andrew McRae

  6. Emergency Strategic Clinical Network, Alberta Health Services, Edmonton, AB, Canada

    Patrick McLane & Scott Fielding

  7. Department of Emergency Medicine, University of Alberta, Edmonton, AB, Canada

    Patrick McLane

  8. Department of Statistics and Actuarial Science, Simon Fraser University, Burnaby, BC, Canada

    X. Joan Hu & Rhonda J. Rosychuk

  9. Department of Mathematical and Statistical Sciences, University of Alberta, Edmonton, AB, Canada

    Rhonda J. Rosychuk

Authors
  1. Anqi Chen
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  2. Maria Ospina
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Correspondence to Rhonda J. Rosychuk.

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Chen, A., Ospina, M., McRae, A. et al. Characteristics of frequent users of emergency departments in Alberta and Ontario, Canada: an administrative data study. Can J Emerg Med 23, 206–213 (2021). https://doi.org/10.1007/s43678-020-00013-7

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  • DOI: https://doi.org/10.1007/s43678-020-00013-7

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