Grant: Travel Awards - Institute Community Support

Emergency Department (ED) costs make up an increasing proportion of Canadian healthcare spending. Patients who use EDs frequently account for 4.5-8% of all ED patients, yet make up almost 30% of the visits. Those patients whose visits to the ED do not result in hospitalization, or whose visits involve care that could more efficiently be provided elsewhere, could likely have their needs met elsewhere at lower cost. Frequent ED users include many different types of patients, for example, those with chronic disease, mental health issues, and substance misuse. Some are more likely to be hospitalized and die compared to non-frequent users, but the risk is not the same for all frequent ED users. For instance, the most extreme frequent ED users (18 or more yearly visits) are admitted and die less often than more moderate frequent users, indicating that they could probably be diverted safely from the ED. My goal is to identify and describe groups of frequent ED users with unmet health needs who can safely be treated outside of the ED. I will do this by linking large databases that collect information about ED visits, admissions, physician billing information, prescription drugs, home care, nursing homes, and provincial deaths. I will start by identifying different frequent ED user groups based on their ED visit patterns and other patient characteristics like age or various illness categories. I will then examine whether these different frequent user groups have different risks of having poor health outcomes (dying or being hospitalized). My results will allow me to identify and target appropriate patient groups for ED diversion, and will inform the development of lower-cost interventions (which will vary by patient group), allowing regions, hospitals and EDs to plan interventions to reduce ED use among these groups. In future studies I will apply the same methods to identify frequent ED user groups in other provinces, and will refine and test developed interventions.