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. 2017 Aug 4;17(1):525.
doi: 10.1186/s12913-017-2453-3.

Factors associated with chronic frequent emergency department utilization in a population with diabetes living in metropolitan areas: a population-based retrospective cohort study

Catherine Hudon  1   2 , Josiane Courteau  3 , Cynthia Krieg  3 , Alain Vanasse  3   4
Affiliations

Factors associated with chronic frequent emergency department utilization in a population with diabetes living in metropolitan areas: a population-based retrospective cohort study

Catherine Hudon et al. BMC Health Serv Res. .

Abstract

Background: A small proportion of patients utilizes a disproportionately large amount of emergency department (ED) resources. Being able to properly identify chronic frequent ED users, i.e. frequent ED users over a multiple-year period, would allow healthcare professionals to intervene before it occurs and, if possible, redirect these patients to more appropriate health services. The objective of this study was to explore the factors associated with chronic frequent ED utilization in a population with diabetes.

Methods: A population-based retrospective cohort study using administrative data was conducted on 62,316 patients with diabetes living in metropolitan areas of Quebec (Canada), having visited an ED during 2006, and still alive in 31 December 2009. The dependant variable was being a chronic frequent ED user, defined as having at least 3 ED visits per year during three consecutive years (2007-2009). Independent variables, measured during 2006, included age, sex, neighbourhood deprivation, affiliation to a general practitioner, and number of physical and mental health comorbidities. Logistic regression and tree-based method were used to identify factors associated with chronic frequent ED use.

Results: A total of 2.6% of the cohort (patients with diabetes and at least one ED visit in 2006) was identified as chronic frequent ED users. These patients accounted for 16% of all ED visits made by the cohort during follow-up. The cumulative effect of a high illness burden combined with mental health disorders was associated with an increased risk of chronic frequent ED use.

Conclusions: Interventions must target the population at higher risk of becoming chronic frequent ED users and should be designed to manage the complex interaction between high illness burden and mental health.

Keywords: Administrative data; Diabetes; Emergency department; Frequent use.

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Conflict of interest statement

Ethics approval and consent to participate

This study was approved by the Research Ethics Board Committee of the Université de Sherbrooke and by the Commission d’accès à l’information of Quebec. Consent to participate was provided by the data owner (RAMQ).

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Study cohort flow diagram. * A patient was considered living with diabetes if he/she received a diagnosis of diabetes (ICD-9: 250; ICD-10: E10-E14) during a hospitalization or at least three physician claims within 1 year with an identical diagnosis. ** MA: Metropolitan area
Fig. 2
Fig. 2
Risk of being a chronic frequent ED user (CFU) in a population with diabetes: multiple logistic regression analysis* (n = 62,316). *Adjusted for all independent variables (fully adjusted model)
Fig. 3
Fig. 3
Risk profiles of being a chronic frequent ED user (CFU) in a women population with diabetes: tree-based approach*. *In each box, n represents the number of CFUs and N the total number of patients (CFUs and Non-CFUs). The percent represents the proportion of CFUs in the subgroup
Fig. 4
Fig. 4
Risk profiles of being a chronic frequent ED user (CFU) in a men population with diabetes: tree-based approach*. *In each box, n represents the number of CFUs and N the total number of patients (CFUs and Non-CFUs). The percent represents the proportion of CFUs in the subgroup
See this image and copyright information in PMC

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