Differences between frequent emergency department users in a secondary rural hospital and a tertiary suburban hospital in central Japan: a prevalence study
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 differenc...
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| Format: | Article |
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BMJ Publishing Group
2020-09-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/10/9/e039030.full |
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| author | Makoto Kaneko Masashi Okubo Michael D Fetters Machiko Inoue Allison K Cullen Furgal Benjamin F Crabtree |
| author_facet | Makoto Kaneko Masashi Okubo Michael D Fetters Machiko Inoue Allison K Cullen Furgal Benjamin F Crabtree |
| author_sort | Makoto Kaneko |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-06e6622aeb014934b700bea06a7bef63 |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2020-09-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-06e6622aeb014934b700bea06a7bef632025-01-08T17:05:08ZengBMJ Publishing GroupBMJ Open2044-60552020-09-0110910.1136/bmjopen-2020-039030Differences between frequent emergency department users in a secondary rural hospital and a tertiary suburban hospital in central Japan: a prevalence studyMakoto Kaneko0Masashi Okubo1Michael D Fetters2Machiko Inoue3Allison K Cullen Furgal4Benjamin F Crabtree5Department of Health Data Science, Yokohama City University, Yokohama, JapanDepartment of Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USAMixed Methods Program and Department of Family Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USADepartment of Family and Community Medicine, Hamamatsu University School of Medicine, Hamamatsu, JapanDepartment of Family Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USARutgers Robert Wood Johnson Medical School, Piscataway, New Jersey, USAObjectives 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.https://bmjopen.bmj.com/content/10/9/e039030.full |
| spellingShingle | Makoto Kaneko Masashi Okubo Michael D Fetters Machiko Inoue Allison K Cullen Furgal Benjamin F Crabtree Differences between frequent emergency department users in a secondary rural hospital and a tertiary suburban hospital in central Japan: a prevalence study BMJ Open |
| title | Differences between frequent emergency department users in a secondary rural hospital and a tertiary suburban hospital in central Japan: a prevalence study |
| title_full | Differences between frequent emergency department users in a secondary rural hospital and a tertiary suburban hospital in central Japan: a prevalence study |
| title_fullStr | Differences between frequent emergency department users in a secondary rural hospital and a tertiary suburban hospital in central Japan: a prevalence study |
| title_full_unstemmed | Differences between frequent emergency department users in a secondary rural hospital and a tertiary suburban hospital in central Japan: a prevalence study |
| title_short | Differences between frequent emergency department users in a secondary rural hospital and a tertiary suburban hospital in central Japan: a prevalence study |
| title_sort | differences between frequent emergency department users in a secondary rural hospital and a tertiary suburban hospital in central japan a prevalence study |
| url | https://bmjopen.bmj.com/content/10/9/e039030.full |
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