Subgroups and risk among frequent emergency department users: Whose needs can safely be met elsewhere?
Canadians spent $6,299 per capita on healthcare in 2016, with emergency department (ED) expenses accounting for an increasing proportion of costs. Policy makers have identified frequent ED users as incurring disproportionately high healthcare costs due to high use of ED and other health services, while clinicians consider them high-risk patients.
However, risk is not uniform amongst frequent ED users and understanding low-risk frequent user subgroups could inform interventions to safely reduce preventable and costly ED overuse and provide alternatives that better address needs.
Dr. Jessica Moe, an Emergency Physician at Vancouver General Hospital and Assistant Professor at the University of British Columbia, is leading a research study to identify distinct clinical subgroups of low-risk frequent users, to develop interventions specifically targeting identified subgroups to redirect care to lower cost settings.
“By carefully characterising these groups, our team will have a higher likelihood of developing successful nterventions,” says Dr. Moe “We are using an innovative approach to precisely identify clinically important patient subgroups with distinct characteristics and visit patterns. Our methodology also allows us to identify previously unanticipated subgroups.”
Identifying subgroups based on visit pattern (e.g., abrupt increase vs. evenly spaced visits over time) and clinical presentation (e.g., mental health vs. chronic medical illness) will allow the researchers to implement flagging tools in existing electronic medical records to identify patients of interest and to plan need-focused interventions (e.g., community counseling vs. pharmacist review).
Future plans for the research team include: engaging with patient and allied health partners; recruiting additional patients to provide the perspectives of each clinical subgroup; and using qualitative methods to explore the development and modes of pilot-implementing and evaluating each intervention developed.
PopData will link 7 data sets from the BC Ministry of Health with Residential Assessment Instrument data for the project.