Identifying Subgroups And Risk Among Frequent Emergency Department Users: Whose needs can safely be met elsewhere?

Project number: 
18-139
Approval date: 
Monday, October 1, 2018
Principal Investigator: 
Moe,Jessica
Institution: 
Vancouver General Hospital (VGH)
Funding Agency: 
Canadian Association of Emergency Physicians,Vancouver Coastal Health Authority (VCH)
Datasets requested: 
consolidation - census geocodes
Hospital Separations (BC Ministry of Health)
Medical Services Plan (BC Ministry of Health)
Consolidation registry (Ministry of Health)
Consolidation - demographic (Ministry of Health)
PharmaNet
NACRS
Deaths (BC Vital Statistics Agency)
Research objective: 

RESEARCH QUESTIONS
1. Describe the demographic, social, clinical, and ED utilization characteristics of patients defined as frequent ED users from 2012 to 2016.
2. Identify frequent ED user subgroups. Specific objectives are to: (i) Develop variables describing visit and clinical characteristics that define patients with unique needs; and (ii) Use cluster analysis to identify subgroups with unique visit patterns and clinical characteristics.
3. Examine whether subgroups of frequent ED users identified in Objective 2 have different risks for adverse outcomes. Specific objectives are to: (i) Define adverse outcomes in the administrative data; (ii) Describe the risk of adverse outcomes in each subgroup of frequent ED users, with a focus on identifying low risk groups in whom safe diversion from the ED could be possible.

HYPOTHESES
1. Subgroups of frequent ED users have distinct patterns of ED visits (e.g., visit clusters) and definable clinical characteristics that indicate unique health needs.
2. Subgroups of frequent ED users with distinct ED visit patterns and clinical profiles have different risks for adverse outcomes.

OBJECTIVES
1. Characterize the top 10% of ED users, which we define as frequent users, from 2012 to 2016.
2. Use cluster analysis to identify subgroups within frequent users with unique visit patterns and characteristics, including the elderly and patients with substance misuse.
3. Describe risks of adverse outcomes for subgroups within frequent users in order to identify characteristics of low-risk patient groups who might be safely diverted from the ED.


Page last revised: December 5, 2018