Douglas Mental Health University Institute, Research Centre, 6875 LaSalle Boulevard, Montreal, Quebec H4H 1R3, Canada; Department of Psychiatry, McGill University, 33 Pine Avenue West, Montreal, Quebec H3A 1A1, Canada.
Douglas Mental Health University Institute, Research Centre, 6875 LaSalle Boulevard, Montreal, Quebec H4H 1R3, Canada.
Am J Emerg Med. 2022 Apr;54:131-141. doi: 10.1016/j.ajem.2022.01.052. Epub 2022 Jan 31.
This study aimed to (1) identify profiles of high emergency department (ED) users (3+ visits/year) among 5409 patients with mental disorders (MD) based on their patterns of ED use and clinical characteristics; (2) identify sociodemographic and service use correlates linked to high ED user profiles; and (3) assess risks of death in a 12-month follow-up period, controlling for sex and age.
Using varied medico-administrative databases, this 5-year study collected patient data for six Quebec (Canada) ED. Latent class analysis was used to distinguish profiles of high ED users for a 3-year period, while bivariate analyses subsequently assessed associations between high ED user profiles and sociodemographic and service use correlates. Survival analysis were also applied to examine relationships between profile memberships of high ED users and risk of death in the 12 months following period of high ED use.
Three profiles of high ED use were identified, Profile 1: 3-year recurrent very high ED users (10+ ED visits/year), Profile 2: 2-year recurrent high ED users, and Profile 3: 1-year high ED users. Profiles differed according to severity of health conditions, intensity of service use, particularly frequent hospitalizations, and risk of death: high in Profile 1, moderate in Profile 2, and low in Profile 3. Compared to 1-year high ED users, 3-year recurrent very high ED users and 2-year recurrent high ED users had poorer health and higher risk of death.
More targeted interventions may be improved for especially recurrent high ED users and recurrent very high ED use.
本研究旨在：(1) 通过分析 5409 例精神障碍（MD）患者的 ED 使用模式和临床特征，确定 3+次/年的高 ED 使用者（HEDU）人群的特征；(2) 确定与 HEDU 特征相关的社会人口学和服务使用因素；(3) 在 12 个月的随访期间，评估死亡风险，同时控制性别和年龄因素。
本 5 年研究使用多种医疗管理数据库，收集了来自魁北克（加拿大）6 个 ED 的患者数据。采用潜在类别分析（LCA）区分了 3 年内 HEDU 的特征，随后进行了单变量分析，评估了 HEDU 特征与社会人口学和服务使用因素之间的关系。还进行了生存分析，以检查高 ED 使用者的特征与高 ED 使用期间 12 个月内死亡风险之间的关系。
确定了 3 种 HEDU 特征，特征 1：3 年复发的非常高 ED 使用者（10+次 ED 就诊/年），特征 2：2 年复发的高 ED 使用者，特征 3：1 年高 ED 使用者。这些特征在健康状况严重程度、服务使用强度（尤其是频繁住院）和死亡风险方面存在差异：特征 1 较高，特征 2 中等，特征 3 较低。与 1 年高 ED 使用者相比，3 年复发的非常高 ED 使用者和 2 年复发的高 ED 使用者的健康状况较差，死亡风险更高。
可能需要为特别是复发的高 ED 使用者和复发的非常高 ED 使用者提供更有针对性的干预措施。
