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

doi:10.1007/s43678-020-00013-7

. 2021 Mar;23(2):206-213.

doi: 10.1007/s43678-020-00013-7. Epub 2021 Jan 4.

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

Anqi Chen¹, Maria Ospina^{2

3}, Andrew McRae^{4

5}, Patrick McLane^{6

7}, X Joan Hu⁸, Scott Fielding⁶, Rhonda J Rosychuk^{9

10

11}

Affiliations

¹ Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, 524 Edmonton Clinic Health Academy, Edmonton, AB, T6G 1C9, Canada.
² Department of Obstetrics and Gynecology, University of Alberta, Edmonton, AB, Canada.
³ School of Public Health, University of Alberta, Edmonton, AB, Canada.
⁴ Department of Emergency Medicine, University of Calgary, Calgary, AB, Canada.
⁵ Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada.
⁶ Emergency Strategic Clinical Network, Alberta Health Services, Edmonton, AB, Canada.
⁷ Department of Emergency Medicine, University of Alberta, Edmonton, AB, Canada.
⁸ Department of Statistics and Actuarial Science, Simon Fraser University, Burnaby, BC, Canada.
⁹ Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, 524 Edmonton Clinic Health Academy, Edmonton, AB, T6G 1C9, Canada. rhonda.rosychuk@ualberta.ca.
¹⁰ Department of Statistics and Actuarial Science, Simon Fraser University, Burnaby, BC, Canada. rhonda.rosychuk@ualberta.ca.
¹¹ Department of Mathematical and Statistical Sciences, University of Alberta, Edmonton, AB, Canada. rhonda.rosychuk@ualberta.ca.

PMID: 33709355
DOI: 10.1007/s43678-020-00013-7

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

Anqi Chen et al. CJEM. 2021 Mar.

. 2021 Mar;23(2):206-213.

doi: 10.1007/s43678-020-00013-7. Epub 2021 Jan 4.

Authors

Anqi Chen¹, Maria Ospina^{2

3}, Andrew McRae^{4

5}, Patrick McLane^{6

7}, X Joan Hu⁸, Scott Fielding⁶, Rhonda J Rosychuk^{9

10

11}

Affiliations

¹ Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, 524 Edmonton Clinic Health Academy, Edmonton, AB, T6G 1C9, Canada.
² Department of Obstetrics and Gynecology, University of Alberta, Edmonton, AB, Canada.
³ School of Public Health, University of Alberta, Edmonton, AB, Canada.
⁴ Department of Emergency Medicine, University of Calgary, Calgary, AB, Canada.
⁵ Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada.
⁶ Emergency Strategic Clinical Network, Alberta Health Services, Edmonton, AB, Canada.
⁷ Department of Emergency Medicine, University of Alberta, Edmonton, AB, Canada.
⁸ Department of Statistics and Actuarial Science, Simon Fraser University, Burnaby, BC, Canada.
⁹ Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, 524 Edmonton Clinic Health Academy, Edmonton, AB, T6G 1C9, Canada. rhonda.rosychuk@ualberta.ca.
¹⁰ Department of Statistics and Actuarial Science, Simon Fraser University, Burnaby, BC, Canada. rhonda.rosychuk@ualberta.ca.
¹¹ Department of Mathematical and Statistical Sciences, University of Alberta, Edmonton, AB, Canada. rhonda.rosychuk@ualberta.ca.

PMID: 33709355
DOI: 10.1007/s43678-020-00013-7

Abstract
in English, French

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.

Keywords: Emergency department; Frequent health service users.

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Comment in

Using administrative data on high system users to call for deeper health system interventions.
Mondoux S, Bielska I, Cheng I. Mondoux S, et al. CJEM. 2021 Mar;23(2):141-142. doi: 10.1007/s43678-021-00094-y. Epub 2021 Mar 11. CJEM. 2021. PMID: 33709370 No abstract available.

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Characteristics of High-Resource Health System Users in Rural and Remote Regions: A Scoping Review.
LeBlanc M, McGaughey T, Peters PA. LeBlanc M, et al. Int J Environ Res Public Health. 2023 Apr 4;20(7):5385. doi: 10.3390/ijerph20075385. Int J Environ Res Public Health. 2023. PMID: 37047999 Free PMC article.
Creating an Inclusive Definition for High Users of Inpatient Hospital Systems That Considers Different Levels of Rurality.
McGaughey T, Kephart G, Dang UJ, Peters PA. McGaughey T, et al. Int J Environ Res Public Health. 2025 Mar 6;22(3):381. doi: 10.3390/ijerph22030381. Int J Environ Res Public Health. 2025. PMID: 40238419 Free PMC article.
Transitions in health care settings for frequent and infrequent users of emergency departments: a population-based retrospective cohort study.
Rosychuk RJ, Chen AA, Ospina MB, McRae AD, Hu XJ, McLane P. Rosychuk RJ, et al. BMC Health Serv Res. 2023 Nov 14;23(1):1250. doi: 10.1186/s12913-023-10260-w. BMC Health Serv Res. 2023. PMID: 37964274 Free PMC article.

References

1. Affleck A, Parks P, Drummond A, Rowe B, Ovens H. Emergency department overcrowding and access block. CJEM. 2013;15(6):59–67.
1. LaCalle E, Rabin E. Frequent users of emergency departments: the myths, the data, and the policy implications. Ann Emerg Med. 2010;56(1):42–8. - DOI
1. Giannouchos TV, Kum H-C, Foster MJ, Ohsfeldt RL. Characteristics and predictors of adult frequent emergency department users in the United States: a systematic literature review. J Eval Clin Pract. 2019;25(3):420–33. - DOI
1. van Tiel S, Rood PPM, Bertoli-Avella AM, Erasmus V, Haagsma J, van Beeck E, et al. Systematic review of frequent users of emergency departments in non-US hospitals: state of the art. Eur J Emerg Med. 2015;22(5):306–15. - DOI
1. Burns TR. Contributing factors of frequent use of the emergency department: a synthesis. Int Emerg Nurs. 2017;35:51–5. - DOI

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[1] Affleck A, Parks P, Drummond A, Rowe B, Ovens H. Emergency department overcrowding and access block. CJEM. 2013;15(6):59–67.

[2] Affleck A, Parks P, Drummond A, Rowe B, Ovens H. Emergency department overcrowding and access block. CJEM. 2013;15(6):59–67.

[3] LaCalle E, Rabin E. Frequent users of emergency departments: the myths, the data, and the policy implications. Ann Emerg Med. 2010;56(1):42–8. - DOI

[4] LaCalle E, Rabin E. Frequent users of emergency departments: the myths, the data, and the policy implications. Ann Emerg Med. 2010;56(1):42–8. - DOI

[5] Giannouchos TV, Kum H-C, Foster MJ, Ohsfeldt RL. Characteristics and predictors of adult frequent emergency department users in the United States: a systematic literature review. J Eval Clin Pract. 2019;25(3):420–33. - DOI

[6] Giannouchos TV, Kum H-C, Foster MJ, Ohsfeldt RL. Characteristics and predictors of adult frequent emergency department users in the United States: a systematic literature review. J Eval Clin Pract. 2019;25(3):420–33. - DOI

[7] van Tiel S, Rood PPM, Bertoli-Avella AM, Erasmus V, Haagsma J, van Beeck E, et al. Systematic review of frequent users of emergency departments in non-US hospitals: state of the art. Eur J Emerg Med. 2015;22(5):306–15. - DOI

[8] van Tiel S, Rood PPM, Bertoli-Avella AM, Erasmus V, Haagsma J, van Beeck E, et al. Systematic review of frequent users of emergency departments in non-US hospitals: state of the art. Eur J Emerg Med. 2015;22(5):306–15. - DOI

[9] Burns TR. Contributing factors of frequent use of the emergency department: a synthesis. Int Emerg Nurs. 2017;35:51–5. - DOI

[10] Burns TR. Contributing factors of frequent use of the emergency department: a synthesis. Int Emerg Nurs. 2017;35:51–5. - DOI

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

Affiliations

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

Authors

Affiliations

Abstract
in English, French

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Cited by

References

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Full Text Sources

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Miscellaneous

Abstract in English, French

Comment in

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Cited by

References

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Full Text Sources

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Miscellaneous

Abstract
in English, French