Epidemiologic Analysis of an Urban, Public Emergency Department's Frequent Users

Epidemiologic Analysis of an Urban, Public Emergency Department's Frequent Users

. Objectives: To determine how the demographic, clinical, and utilization characteristics of emergency department (ED) frequent users differ from those of other ED patients. Methods: A cross‐sectional and retrospective cohort study was performed using a database of all 348,858 visits to the San Fran...

Full description

Saved in:
Bibliographic Details
Published in:Academic emergency medicine Vol. 7; no. 6; pp. 637 - 646
Main Authors: Mandelberg, Joshua H., Kuhn, Robert E., Kohn, Michael A.
Format: Journal Article
Language:English
Published: Oxford, UK Blackwell Publishing Ltd 01-06-2000
Subjects:
Adolescent
Adult
Age Distribution
Aged
Child
Child, Preschool
Cohort Studies
Confidence Intervals
Cross-Sectional Studies
emergency department
Emergency Service, Hospital - statistics & numerical data
Female
frequent users
Hospitals, Municipal - statistics & numerical data
Humans
Incidence
Infant
Infant, Newborn
Logistic Models
Male
Middle Aged
Multivariate Analysis
Odds Ratio
Retrospective Studies
Risk Factors
San Francisco - epidemiology
Sex Distribution
Socioeconomic Factors
Urban Population - statistics & numerical data
Utilization Review - statistics & numerical data
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:. Objectives: To determine how the demographic, clinical, and utilization characteristics of emergency department (ED) frequent users differ from those of other ED patients. Methods: A cross‐sectional and retrospective cohort study was performed using a database of all 348,858 visits to the San Francisco General Hospital ED during a five‐year period (July 1, 1993, to June 30, 1998). A “frequent user” visited the ED five or more times in a 12‐month period. Results: Frequent users constituted 3.9% of ED patients but accounted for 20.5% of ED visits. The relative risk (RR) of frequent use was high among patients who were homeless (RR = 4.5), African American (RR = 1.8), and Medi‐Cal sponsored (RR = 2.1). Frequent users were more likely to be seen for alcohol withdrawal (RR = 4.4), alcohol dependence (RR = 3.4), and alcohol intoxication (RR = 2.4). Frequent users were also more likely to visit for exacerbations of chronic conditions, including sickle cell anemia (RR = 8.0), renal failure (RR = 3.6), and chronic obstructive pulmonary disease (RR = 3.3). They were less likely to visit for all forms of trauma (RR = 0.43). Survival analysis showed that only 38% of frequent users for one year remained frequent users the next year. However, 56% of frequent users for two consecutive years remained frequent users in the third year. Conclusions: Frequent use of the ED reflects the urban social problems of homelessness, poverty, alcohol abuse, and chronic illness. Frequent use of the ED shows a high rate of decline from one year to the next. This rate of decline slows after the first year and suggests the existence of a smaller group of chronic frequent users.
Bibliography:ObjectType-Article-1
SourceType-Scholarly Journals-1
ObjectType-Feature-2
content type line 23
ISSN:1069-6563
1553-2712
DOI:10.1111/j.1553-2712.2000.tb02037.x