Grant: Operating Grant: Secondary Data Analysis

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 to 30% of the visits. Those making visits that do not result in hospital admission 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 others are at lower risk. For instance, the most extreme ED users (18 or more visits per year) are admitted and die less often than other users, indicating that they could probably be diverted. Our goal is to identify and describe groups of frequent ED users with unmet health needs who can safely be treated outside of the ED. We will do this by linking large databases that collect information about ED visits, hospitalizations, prescription drugs, home care, and nursing homes. We will start by describing frequent ED user groups, and examining their risks of poor health outcomes. We will look at factors that facilitate starting or stopping frequent ED use in order to plan interventions. Our results will allow policy makers to target appropriate patients groups for ED diversion, and allow us to plan for interventions to reduce ED use among them. It will also allow us to develop interventions to prevent patients from becoming frequent users. In future studies we will validate our results in other databases to ensure that our results are applicable nationally, and develop, refine and test the interventions we will plan.