Characteristics of Non-Emergent Visits in Emergency Departments: Profiles and Longitudinal Pattern Changes in Taiwan, 2000-2010

Abstract

An increasing number of emergency department (ED) visits have posed a challenge to health systems in many countries, but an understanding of non-emergent ED visits has remained limited and contentious. This retrospective study analyzed ED visits using three representative cohorts from routine data to explore the profiles and longitudinal pattern changes of non-emergent ED visits in Taiwan. Systematic-, personal-, and ED visit-level data were analyzed using a logistic regression model. Average marginal effects were calculated to compare the effects of each factor. The annual ED visit rate increased up to 261.3 per 1000 population in 2010, and a significant one-third of visits were considered as non-emergent. The rapidly growing utilization of ED visits underwent a watershed change after cost-sharing payments between patients and medical institutions were increased in 2005. In addition to cohort effects resulting from cost-sharing payment changes, all factors were significantly associated with non-emergent ED visits with different levels of impact. We concluded that non-emergent ED visits were associated with multifaceted factors, but the change to cost-sharing payment, being female, younger age, and geographical residence were the most predictive factors. This information would enhance the implementation of evidence-based strategies to optimize ED use.

Keywords: cohort effect; emergent department (ED); health utilization; non-emergent ED visits.

Figure 1

Annual emergency department (ED) visit, growth rates, and proportions of ED visit classification by study year from three representative study cohorts (LHID2000, LHID2005, LHID2010) in Taiwan. (n = 1,000,000 for each cohort). Growth rates of ED visits are expressed in percentages and overlaid on lines between study years. Background shading in different colors represents different cost-sharing payment schemes. The sum of the percentages is less than 100 because conditions such as psychosis and alcohol or drug problem (<2%) are not shown in the figure.

Figure 2

Average marginal effects (AME) of factors for non-emergent ED visits ordered by effect size from three representative study cohorts (LHID2000, LHID2005, LHID2010) in Taiwan. (n = 1,000,000 for each cohort, total ED visits, n = 475,862). AME were calculated using a logistic model adjusted for listed factors, in addition to Charlson’s index. The most frequent level of each factor was used as the base value (reference line at zero).