Lau Tammy, Maltby Alana, Ali Shehzad, Moran Valérie, Wilk Piotr
Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada.
Bruyère Research Institute, Ottawa, Ontario, Canada.
Acad Emerg Med. 2022 Nov;29(11):1329-1337. doi: 10.1111/acem.14587. Epub 2022 Sep 26.
This study had two objectives: (1) to estimate the prevalence of preventable emergency department (ED) visits during the 2016-2020 time period among those living in 19 large urban centers in Alberta and Ontario, Canada, and (2) to assess if the definition of preventable ED visits matters in estimating the prevalence.
A retrospective, population-based study of ED visits that were reported to the National Ambulatory Care Reporting System from April 1, 2016, to March 31, 2020, was conducted. Preventable ED visits were operationalized based on the following approaches: (1) Canadian Triage and Acuity Scale (CTAS), (2) ambulatory care-sensitive conditions (ACSC), (3) family practice-sensitive conditions (FPSC), and (4) sentinel nonurgent conditions (SNC). The overall proportion of ED visits that were preventable was estimated. We also estimated the adjusted relative risks of preventable ED visits by patients' sex and age, fiscal year, province of residence, and census metropolitan area (CMA) of residence.
There were 20,171,319 ED visits made by 8,919,618 patients ages 1 to 74 who resided in one of the 19 CMAs in Alberta or Ontario. On average, there were 2.26 visits per patient over the period of 4 fiscal years; most patients made one (44.22%) or two ED visits (20.72%). The overall unadjusted prevalence of preventable ED visits varied by definition; 35.33% of ED visits were defined as preventable based on CTAS, 12.88% based on FPSC, 3.41% based on SNC, and 2.33% based on ACSC.
There is a substantial level of variation in prevalence estimates across definitions of preventable ED visits, and care should be taken when interpreting these estimates as each has a different meaning and may lead to different conclusions. The conceptualization and measurement of preventable ED visits is complex and multifaceted and may not be adequately captured by a single definition.
本研究有两个目的：（1）估计2016 - 2020年期间加拿大艾伯塔省和安大略省19个大型城市中心居民中可预防的急诊科就诊率，（2）评估可预防的急诊科就诊定义在估计患病率时是否重要。
对2016年4月1日至2020年3月31日期间向国家门诊护理报告系统报告的急诊科就诊情况进行了一项基于人群的回顾性研究。可预防的急诊科就诊根据以下方法确定：（1）加拿大分诊和 acuity 量表（CTAS），（2）门诊护理敏感疾病（ACSC），（3）家庭医疗敏感疾病（FPSC），以及（4）哨兵非紧急疾病（SNC）。估计了可预防的急诊科就诊的总体比例。我们还按患者的性别和年龄、财政年度、居住省份以及居住的人口普查大都会区（CMA）估计了可预防的急诊科就诊的调整后相对风险。
居住在艾伯塔省或安大略省19个CMA之一的1至74岁患者进行了20,171,319次急诊科就诊。在4个财政年度期间，平均每位患者就诊2.26次；大多数患者就诊1次（44.22%）或2次（20.72%）。可预防的急诊科就诊的总体未调整患病率因定义而异；基于CTAS，35.33%的急诊科就诊被定义为可预防，基于FPSC为12.88%，基于SNC为3.41%，基于ACSC为2.33%。
可预防的急诊科就诊定义的患病率估计存在很大差异，在解释这些估计时应谨慎，因为每个定义都有不同的含义，可能会导致不同的结论。可预防的急诊科就诊的概念化和测量是复杂且多方面的，可能无法通过单一的定义充分体现。
