PRP073: Development of profiles of frequent emergency department users based on medico administrative data
Yohann Chiu, PhD; Isabelle Dufour, MSc, RN; Josiane Courteau; Marie-France Dubois; Nicolas Elazhary, MD, EM and fellow CCFM; Catherine Hudon, MD, PhD; Alain Vanasse, MD, PhD; Maud-Christine Chouinard, PhD, RN
Objective: To establish and characterize profiles of frequent ED users in an adult population with chronic diseases in Québec (Canada).
Study Design: This is a retrospective population-based cohort study using Québec medico administrative databases. Profiles were constructed using latent class analysis. It is a probability-based model that allowed the construction of homogeneous subgroups based on patient observed variables. Those variables included type of drug insurance plan, physical comorbidity index, and diagnoses of mental health conditions, chronic non-cancer pain, injury, alcohol abuse, and drug abuse.
Population studied: Inclusion criteria: adults (≥18 year old) living in an urban area, with an ED visit between 2012 and 2013 (index visit), and previously diagnosed with at least one ACSC. Frequent ED use was defined as having ≥5 visits during the year following their index date. Exclusion criteria: patients diagnosed with dementia or who died within the year following their index date.
Outcome Measures: Other variables were used to describe the profiles. Those included age, sex, social and material deprivation, number of previous ED visits in the last year, previous hospitalization in the last two years, presence and type of ACSC, and chronic frequent use (frequent use during 3 consecutive years).
Results: Out of 451,775 included patients, 13,676 (3.03 %) were frequent users. They presented four main profiles with distinct characteristics: 1) “Low morbidity frequent use” (n = 5,501), 2) “High physical comorbidity” (n = 3,202), 3), “Alcohol/Substance abuse or mental health” (n = 2,660), and 4) “Chronic non cancer pain or injury” (n = 2,313).
Conclusions: The four profiles have distinct medical and socioeconomic characteristics. Those profiles provide useful information for developing tailored interventions that would address the specific needs of each type of frequent ED users. Results from this study could also be integrated in on-site questionnaires.