Differences between frequent emergency department users in a secondary rural hospital and a tertiary suburban hospital in central Japan: a prevalence study

Makoto Kaneko; Machiko Inoue; Masashi Okubo; Allison K.Cullen Furgal; Benjamin F. Crabtree; Michael D. Fetters

doi:https://doi.org/10.1136/bmjopen-2020-039030

Differences between frequent emergency department users in a secondary rural hospital and a tertiary suburban hospital in central Japan: a prevalence study

Makoto Kaneko, Machiko Inoue, Masashi Okubo, Allison K.Cullen Furgal, Benjamin F. Crabtree, Michael D. Fetters

Robert Wood Johnson Medical School (RWJMS), Family Medicine

Rutgers, The State University

Research output: Contribution to journal › Article › peer-review

Abstract

Objectives Although frequent emergency department (ED) use is a global issue, little research has been conducted in a country like Japan where universal health insurance is available. The study aims to (1) document the proportion of ED visits that are by frequent users and (2) describe the differences in characteristics of frequent ED users and other ED users including expenditures between a secondary and a tertiary hospital. Design A prevalence study for a period of 1 year. Setting A secondary hospital and a tertiary hospital in central Japan. Participants All patients who presented to the EDs. Primary outcome measures We defined frequent ED user as a patient who visited the ED≥5 times/year. The main outcome measures were the proportion of frequent ED users among all ED users and the proportion of healthcare expenditures by the frequent ED users among all ED expenditures. Results Of 25 231 ED visits over 1 year, 134 frequent ED users accounted for 1043 visits -0.66% of all ED users, comprised 4.1% of all ED visits, and accounted for 1.9% of total healthcare expenditures. Median ED visits per one frequent ED user was 7.9. At the patient level, after adjusting for age, gender and receiving public assistance, older age (OR 1.01, 95% CI: 1.00 to 1.02) and receiving public assistance (OR 7.19, 95% CI 2.87 to 18.07) had an association with frequent ED visits. At the visit-level analysis, evaluation by internal medicine (OR 1.27, 95% CI 1.02 to 1.57), psychiatry (OR 124.69, 95% CI 85.89 to 181.01) and obstetrics/gynaecology (OR 2.77, 95% CI 2.09 to 3.67) were associated with frequent ED visits. Conclusion The proportion of frequent ED users, of total visits, and of expenditures attributable to them -while still in the low end of the distribution of published ranges -are lower in this study from Japan than in reports from many other countries.

Original language	English (US)
Article number	039030
Journal	BMJ open
Volume	10
Issue number	9
DOIs	https://doi.org/10.1136/bmjopen-2020-039030
State	Published - Sep 7 2020

ASJC Scopus subject areas

Medicine(all)

Keywords

accident & emergency medicine
health economics
health services administration & management
international health services

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https://doi.org/10.1136/bmjopen-2020-039030

Cite this

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title = "Differences between frequent emergency department users in a secondary rural hospital and a tertiary suburban hospital in central Japan: a prevalence study",

abstract = "Objectives Although frequent emergency department (ED) use is a global issue, little research has been conducted in a country like Japan where universal health insurance is available. The study aims to (1) document the proportion of ED visits that are by frequent users and (2) describe the differences in characteristics of frequent ED users and other ED users including expenditures between a secondary and a tertiary hospital. Design A prevalence study for a period of 1 year. Setting A secondary hospital and a tertiary hospital in central Japan. Participants All patients who presented to the EDs. Primary outcome measures We defined frequent ED user as a patient who visited the ED≥5 times/year. The main outcome measures were the proportion of frequent ED users among all ED users and the proportion of healthcare expenditures by the frequent ED users among all ED expenditures. Results Of 25 231 ED visits over 1 year, 134 frequent ED users accounted for 1043 visits -0.66% of all ED users, comprised 4.1% of all ED visits, and accounted for 1.9% of total healthcare expenditures. Median ED visits per one frequent ED user was 7.9. At the patient level, after adjusting for age, gender and receiving public assistance, older age (OR 1.01, 95% CI: 1.00 to 1.02) and receiving public assistance (OR 7.19, 95% CI 2.87 to 18.07) had an association with frequent ED visits. At the visit-level analysis, evaluation by internal medicine (OR 1.27, 95% CI 1.02 to 1.57), psychiatry (OR 124.69, 95% CI 85.89 to 181.01) and obstetrics/gynaecology (OR 2.77, 95% CI 2.09 to 3.67) were associated with frequent ED visits. Conclusion The proportion of frequent ED users, of total visits, and of expenditures attributable to them -while still in the low end of the distribution of published ranges -are lower in this study from Japan than in reports from many other countries.",

keywords = "accident & emergency medicine, health economics, health services administration & management, international health services",

author = "Makoto Kaneko and Machiko Inoue and Masashi Okubo and Furgal, {Allison K.Cullen} and Crabtree, {Benjamin F.} and Fetters, {Michael D.}",

note = "Publisher Copyright: {\textcopyright} Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.",

year = "2020",

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doi = "https://doi.org/10.1136/bmjopen-2020-039030",

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T1 - Differences between frequent emergency department users in a secondary rural hospital and a tertiary suburban hospital in central Japan

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AU - Kaneko, Makoto

AU - Inoue, Machiko

AU - Okubo, Masashi

AU - Furgal, Allison K.Cullen

AU - Crabtree, Benjamin F.

AU - Fetters, Michael D.

N1 - Publisher Copyright: © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

PY - 2020/9/7

Y1 - 2020/9/7

N2 - Objectives Although frequent emergency department (ED) use is a global issue, little research has been conducted in a country like Japan where universal health insurance is available. The study aims to (1) document the proportion of ED visits that are by frequent users and (2) describe the differences in characteristics of frequent ED users and other ED users including expenditures between a secondary and a tertiary hospital. Design A prevalence study for a period of 1 year. Setting A secondary hospital and a tertiary hospital in central Japan. Participants All patients who presented to the EDs. Primary outcome measures We defined frequent ED user as a patient who visited the ED≥5 times/year. The main outcome measures were the proportion of frequent ED users among all ED users and the proportion of healthcare expenditures by the frequent ED users among all ED expenditures. Results Of 25 231 ED visits over 1 year, 134 frequent ED users accounted for 1043 visits -0.66% of all ED users, comprised 4.1% of all ED visits, and accounted for 1.9% of total healthcare expenditures. Median ED visits per one frequent ED user was 7.9. At the patient level, after adjusting for age, gender and receiving public assistance, older age (OR 1.01, 95% CI: 1.00 to 1.02) and receiving public assistance (OR 7.19, 95% CI 2.87 to 18.07) had an association with frequent ED visits. At the visit-level analysis, evaluation by internal medicine (OR 1.27, 95% CI 1.02 to 1.57), psychiatry (OR 124.69, 95% CI 85.89 to 181.01) and obstetrics/gynaecology (OR 2.77, 95% CI 2.09 to 3.67) were associated with frequent ED visits. Conclusion The proportion of frequent ED users, of total visits, and of expenditures attributable to them -while still in the low end of the distribution of published ranges -are lower in this study from Japan than in reports from many other countries.

AB - Objectives Although frequent emergency department (ED) use is a global issue, little research has been conducted in a country like Japan where universal health insurance is available. The study aims to (1) document the proportion of ED visits that are by frequent users and (2) describe the differences in characteristics of frequent ED users and other ED users including expenditures between a secondary and a tertiary hospital. Design A prevalence study for a period of 1 year. Setting A secondary hospital and a tertiary hospital in central Japan. Participants All patients who presented to the EDs. Primary outcome measures We defined frequent ED user as a patient who visited the ED≥5 times/year. The main outcome measures were the proportion of frequent ED users among all ED users and the proportion of healthcare expenditures by the frequent ED users among all ED expenditures. Results Of 25 231 ED visits over 1 year, 134 frequent ED users accounted for 1043 visits -0.66% of all ED users, comprised 4.1% of all ED visits, and accounted for 1.9% of total healthcare expenditures. Median ED visits per one frequent ED user was 7.9. At the patient level, after adjusting for age, gender and receiving public assistance, older age (OR 1.01, 95% CI: 1.00 to 1.02) and receiving public assistance (OR 7.19, 95% CI 2.87 to 18.07) had an association with frequent ED visits. At the visit-level analysis, evaluation by internal medicine (OR 1.27, 95% CI 1.02 to 1.57), psychiatry (OR 124.69, 95% CI 85.89 to 181.01) and obstetrics/gynaecology (OR 2.77, 95% CI 2.09 to 3.67) were associated with frequent ED visits. Conclusion The proportion of frequent ED users, of total visits, and of expenditures attributable to them -while still in the low end of the distribution of published ranges -are lower in this study from Japan than in reports from many other countries.

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Differences between frequent emergency department users in a secondary rural hospital and a tertiary suburban hospital in central Japan: a prevalence study

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Keywords

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