加拿大不列颠哥伦比亚省频繁使用急诊部患者的特征：一项回顾性分析。
Characteristics of frequent emergency department users in British Columbia, Canada: a retrospective analysis.
机构信息
Departments of Emergency Medicine (Moe, O'Sullivan, Grafstein, Hohl) and Family Practice (McGregor), University of British Columbia; Department of Emergency Medicine (Moe, Hohl), Vancouver General Hospital, Vancouver, BC; ICES Central (Schull); Department of Medicine (Schull), University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Dong, Holroyd), University of Alberta; Emergency Strategic Clinical Network (Holroyd), Alberta Health Services, Edmonton, Alta.; Patients for Patient Safety Canada (Trimble), Roberts Creek, BC; School of Population and Public Health (McGrail), University of British Columbia; Population Data BC (McGrail), Vancouver, BC
Departments of Emergency Medicine (Moe, O'Sullivan, Grafstein, Hohl) and Family Practice (McGregor), University of British Columbia; Department of Emergency Medicine (Moe, Hohl), Vancouver General Hospital, Vancouver, BC; ICES Central (Schull); Department of Medicine (Schull), University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Dong, Holroyd), University of Alberta; Emergency Strategic Clinical Network (Holroyd), Alberta Health Services, Edmonton, Alta.; Patients for Patient Safety Canada (Trimble), Roberts Creek, BC; School of Population and Public Health (McGrail), University of British Columbia; Population Data BC (McGrail), Vancouver, BC.
出版信息
CMAJ Open. 2021 Mar 2;9(1):E134-E141. doi: 10.9778/cmajo.20200168. Print 2021 Jan-Mar.
BACKGROUND
Frequent emergency department users disproportionately account for rising health care costs. We aimed to characterize frequent emergency department users in British Columbia, Canada.
METHODS
We performed a retrospective analysis using health administrative databases. We included patients aged 18 years or more with at least 1 emergency department visit from 2012/13 to 2015/16, linked to hospital, physician billing, prescription and mortality data. We used annual emergency department visits made by the top 10% of patients to define frequent users (≥ 3 visits/year).
RESULTS
Over the study period, 13.8%-15.3% of patients seen in emergency departments were frequent users. We identified 205 136 frequent users among 1 196 353 emergency department visitors. Frequent users made 40.3% of total visits in 2015/16. From 2012/13 to 2015/16, their visit rates per 100 000 BC population showed a relative increase of 21.8%, versus 13.1% among all emergency department patients. Only 1.8% were frequent users in all study years. Mental illness accounted for 8.2% of visits among those less than 60 years of age, and circulatory or respiratory diagnoses for 13.3% of visits among those aged 60 or more. In 2015/16, frequent users were older and had lower household incomes than nonfrequent users; the sex distribution was similar. Frequent users had more prescriptions (median 9, interquartile range [IQR] 5-14 v. 1, IQR 1-3), primary care visits (median 15, IQR 9-27 v. 7, IQR 4-12) and hospital admissions (median 2, IQR 1-3 v. 1, IQR 1-1), and higher 1-year mortality (10.2% v. 3.5%) than nonfrequent users.
INTERPRETATION
Emergency department use by frequent users increased in BC between 2012/13 and 2015/16; these patients were heterogenous, had high mortality and rarely remained frequent users over multiple years. Our results suggest that interventions must account for heterogeneity and address triggers of frequent use episodes.
背景
高频次使用急诊的患者在不断增加，其医疗费用也在不断上涨。本研究旨在对加拿大不列颠哥伦比亚省的高频次使用急诊的患者进行特征描述。
方法
我们使用健康管理数据库进行回顾性分析。研究对象为 2012/13 年至 2015/16 年期间至少有 1 次急诊就诊记录的 18 岁及以上患者，并与医院、医生计费、处方和死亡率数据相关联。我们用每年就诊频次最高的 10%的患者就诊频次定义高频次使用者（≥3 次/年）。
结果
研究期间，13.8%~15.3%的急诊就诊患者为高频次使用者。在 1 196 353 例急诊就诊者中，我们共识别出 205 136 例高频次使用者。在 2015/16 年，高频次使用者的就诊量占总就诊量的 40.3%。从 2012/13 年到 2015/16 年，高频次使用者的就诊率每年每 10 万不列颠哥伦比亚省居民增加 21.8%，而所有急诊患者的就诊率每年增加 13.1%。在所有研究年份中，仅有 1.8%的患者为高频次使用者。60 岁以下人群中，8.2%的就诊原因为精神疾病，60 岁及以上人群中，13.3%的就诊原因为循环或呼吸系统疾病。2015/16 年，高频次使用者比非高频次使用者年龄更大，家庭收入更低；性别分布相似。高频次使用者的处方数量更多（中位数 9，四分位距[IQR] 5-14 v. 1，IQR 1-3）、初级保健就诊次数更多（中位数 15，IQR 9-27 v. 7，IQR 4-12）、住院次数更多（中位数 2，IQR 1-3 v. 1，IQR 1-1），1 年死亡率更高（10.2% v. 3.5%）。
结论
2012/13 年至 2015/16 年期间，不列颠哥伦比亚省高频次使用急诊的患者数量有所增加；这些患者具有异质性，死亡率较高，且很少连续多年为高频次使用者。本研究结果提示，干预措施必须考虑到这种异质性，并解决高频次就诊的触发因素。
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