Factors associated with frequent use of emergency services in a medical center.

BACKGROUND AND PURPOSE Overuse of emergency department (ED) services can result in overcrowding and a substantial increase of health care cost. The purpose of this study was to characterize frequent ED users and to identify the factors associated with frequent ED use in a hospital in Taiwan. METHODS This retrospective study used Andersen's Behavioral Model of Health Service Use as a framework. Frequent ED users (>/= 4 visits/year) and infrequent ED users (< 4 visits/ year) were selected randomly from patients visiting the adult ED of a medical center in central Taiwan from October 1, 2000 to September 30, 2001. Telephone interviews were completed for 200 frequent users and 600 infrequent users. Logistic regression analysis was performed to identify factors associated with frequent ED use. RESULTS Frequent ED users comprised 3.5% of total ED patients, accounting for 14.3% of the ED visits. Significant factors associated with frequent ED use were: a regular source of care [odds ratio (OR), 2.79; 95% confidence interval (CI), 1.63 to 4.79], alcoholism (OR, 19.4; 95% CI, 3.84 to 98.0), high outpatient clinic use (OR, 2.66; 95% CI, 1.72 to 4.11), previous hospitalization (OR, 3.06; 95% CI, 1.94 to 4.82), chronic disease (OR, 3.07; 95% CI, 1.78 to 5.29), cancer (OR, 4.16; 95% CI, 1.29 to 13.4), gastrointestinal disease (OR, 6.28; 95% CI, 1.95 to 20.2), cardiovascular disease (OR, 8.41; 95% CI, 2.51 to 28.1), pulmonary disease (OR, 4.21; 95% CI, 1.04 to 17.1), low level of emergency (OR, 5.43; 95% CI, 3.40 to 8.68), and dissatisfaction with treatment outcome (OR, 2.62; 95% CI, 1.32 to 5.20). CONCLUSIONS Frequent ED users were responsible for a disproportionate number of the total ED visits. Andersen's "need factors" were strongly associated with frequent ED use, while the investigated predisposing factors were not significant. Most patients who visited the ED had a low level of emergency. These findings suggest that implementation of an integrated delivery system may decrease ED use.

[1]  U. Rosenqvist,et al.  Heavy users of an emergency department--a two year follow-up study. , 1987, Social science & medicine.

[2]  J. Richards,et al.  Overcrowding in the nation's emergency departments: complex causes and disturbing effects. , 2000, Annals of emergency medicine.

[3]  J. Morris,et al.  An alternative in terminal care: results of the National Hospice Study. , 1986, Journal of chronic diseases.

[4]  T. Bond,et al.  Analysis of chronic emergency department use. , 1999, Nursing economic$.

[5]  K. O'Brien,et al.  The effects of clinical case management on hospital service use among ED frequent users. , 2000, The American journal of emergency medicine.

[6]  C. Fernandes,et al.  Frequent users of the emergency department: a program to improve care and reduce visits. , 2000, CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne.

[7]  T. Mitchell.  Nonurgent emergency department visits--whose definition? , 1994, Annals of emergency medicine.

[8]  A. Da Costa,et al.  Appropriateness of emergency department visits in a Portuguese university hospital. , 2001, Annals of emergency medicine.

[9]  J. Viel,et al.  Using the hospital emergency department as a regular source of care , 1997, European Journal of Epidemiology.

[10]  R. Malone,et al.  Heavy users of emergency services: social construction of a policy problem. , 1995, Social science & medicine.

[11]  P. Plunkett,et al.  Characteristics of attenders and their attendances at an urban accident and emergency department over a one year period. , 1999, Journal of accident & emergency medicine.

[12]  J. C. Lo,et al.  The impact of hospices on health care expenditures--the case of Taiwan. , 2002, Social science & medicine.

[13]  Burt Cw,et al.  Trends in hospital emergency department utilization: United States, 1992-99. , 2001 .

[14]  S. Sanford,et al.  An analysis of frequent users of emergency care at an urban university hospital. , 1998, Annals of emergency medicine.

[15]  R H Brook,et al.  Patients who leave a public hospital emergency department without being seen by a physician. Causes and consequences. , 1991, JAMA.

[16]  K. Okuyemi,et al.  Describing and predicting frequent users of an emergency department. , 2001, Journal of the Association for Academic Minority Physicians : the official publication of the Association for Academic Minority Physicians.

[17]  S. Sheps,et al.  Emergency department use as a component of total ambulatory care: a population perspective. , 1998, CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne.

[18]  R. Andersen.  Revisiting the behavioral model and access to medical care: does it matter? , 1995, Journal of health and social behavior.

[19]  S. Peiró,et al.  Inappropriate use of an accident and emergency department: magnitude, associated factors, and reasons--an approach with explicit criteria. , 2001, Annals of emergency medicine.

[20]  S. Göransson,et al.  Frequent use of the hospital emergency department is indicative of high use of other health care services. , 2001, Annals of emergency medicine.

[21]  A. Kellermann.  Nonurgent emergency department visits. Meeting an unmet need. , 1994, JAMA.

[22]  S. M. Wang,et al.  ED overcrowding in Taiwan: facts and strategies. , 1999, The American journal of emergency medicine.

[23]  David J. Magid,et al.  Patients who leave a public hospital emergency department without being seen by a physician , 1992 .

[24]  R. Kravitz,et al.  Frequent overcrowding in U.S. emergency departments. , 2001, Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.

[25]  B. Santos-Eggimann.  Increasing use of the emergency department in a Swiss hospital: observational study based on measures of the severity of cases , 2002, BMJ : British Medical Journal.

[26]  H. Hansagi,et al.  Repeated use of the emergency department: qualitative study of the patient's perspective , 2001, Emergency medicine journal : EMJ.

[27]  L. McCaig,et al.  Trends in hospital emergency department utilization: United States, 1992-99. , 2001, Vital and health statistics. Series 13, Data from the National Health Survey.

[28]  P. Allebeck,et al.  Frequency of emergency department attendances as a predictor of mortality: nine-year follow-up of a population-based cohort. , 1990, Journal of public health medicine.

[29]  E J Orav,et al.  Nonurgent emergency department visits: the effect of having a regular doctor. , 1998, Medical care.

[30]  S Capewell,et al.  The continuing rise in emergency admissions , 1996, BMJ.

[31]  Ò. Miró,et al.  Decreased health care quality associated with emergency department overcrowding. , 1999, European journal of emergency medicine : official journal of the European Society for Emergency Medicine.