Epidemiologic analysis of an urban, public emergency department's frequent users. Export

@article{citeulike:350077, abstract = {OBJECTIVES: To determine how the demographic, clinical, and utilization characteristics of emergency department (ED) frequent users differ from those of other ED patients. METHODS: A cross-sectional and retrospective cohort study was performed using a database of all 348,858 visits to the San Francisco General Hospital ED during a five-year period (July 1, 1993, to June 30, 1998). A "frequent user" visited the ED five or more times in a 12-month period. RESULTS: Frequent users constituted 3.9\% of ED patients but accounted for 20.5\% of ED visits. The relative risk (RR) of frequent use was high among patients who were homeless (RR = 4.5), African American (RR = 1.8), and Medi-Cal sponsored (RR = 2.1). Frequent users were more likely to be seen for alcohol withdrawal (RR = 4.4), alcohol dependence (RR = 3.4), and alcohol intoxication (RR = 2.4). Frequent users were also more likely to visit for exacerbations of chronic conditions, including sickle cell anemia (RR = 8.0), renal failure (RR = 3.6), and chronic obstructive pulmonary disease (RR = 3.3). They were less likely to visit for all forms of trauma (RR = 0.43). Survival analysis showed that only 38\% of frequent users for one year remained frequent users the next year. However, 56\% of frequent users for two consecutive years remained frequent users in the third year. CONCLUSIONS: Frequent use of the ED reflects the urban social problems of homelessness, poverty, alcohol abuse, and chronic illness. Frequent use of the ED shows a high rate of decline from one year to the next. This rate of decline slows after the first year and suggests the existence of a smaller group of chronic frequent users.}, address = {University of California, San Francisco, School of Medicine, USA.}, author = {Mandelberg, J. H. and Kuhn, R. E. and Kohn, M. A.}, citeulike-article-id = {350077}, citeulike-linkout-0 = {http://view.ncbi.nlm.nih.gov/pubmed/10905642}, citeulike-linkout-1 = {http://www.hubmed.org/display.cgi?uids=10905642}, issn = {1069-6563}, journal = {Acad Emerg Med}, keywords = {ed, emergencydepartment}, month = {June}, number = {6}, pages = {637--646}, posted-at = {2005-10-13 23:51:41}, priority = {2}, title = {Epidemiologic analysis of an urban, public emergency department's frequent users.}, url = {http://view.ncbi.nlm.nih.gov/pubmed/10905642}, volume = {7}, year = {2000} }

TY - JOUR ID - citeulike:350077 L3 - citeulike-article-id:350077 N2 - OBJECTIVES: To determine how the demographic, clinical, and utilization characteristics of emergency department (ED) frequent users differ from those of other ED patients. METHODS: A cross-sectional and retrospective cohort study was performed using a database of all 348,858 visits to the San Francisco General Hospital ED during a five-year period (July 1, 1993, to June 30, 1998). A "frequent user" visited the ED five or more times in a 12-month period. RESULTS: Frequent users constituted 3.9% of ED patients but accounted for 20.5% of ED visits. The relative risk (RR) of frequent use was high among patients who were homeless (RR = 4.5), African American (RR = 1.8), and Medi-Cal sponsored (RR = 2.1). Frequent users were more likely to be seen for alcohol withdrawal (RR = 4.4), alcohol dependence (RR = 3.4), and alcohol intoxication (RR = 2.4). Frequent users were also more likely to visit for exacerbations of chronic conditions, including sickle cell anemia (RR = 8.0), renal failure (RR = 3.6), and chronic obstructive pulmonary disease (RR = 3.3). They were less likely to visit for all forms of trauma (RR = 0.43). Survival analysis showed that only 38% of frequent users for one year remained frequent users the next year. However, 56% of frequent users for two consecutive years remained frequent users in the third year. CONCLUSIONS: Frequent use of the ED reflects the urban social problems of homelessness, poverty, alcohol abuse, and chronic illness. Frequent use of the ED shows a high rate of decline from one year to the next. This rate of decline slows after the first year and suggests the existence of a smaller group of chronic frequent users. IS - 6 JF - Acad Emerg Med SN - 1069-6563 AD - University of California, San Francisco, School of Medicine, USA. EP - 646 TI - Epidemiologic analysis of an urban, public emergency department's frequent users. VL - 7 SP - 637 KW - ed KW - emergencydepartment AU - Mandelberg, JH AU - Kuhn, RE AU - Kohn, MA PY - 2000/06// UR - http://view.ncbi.nlm.nih.gov/pubmed/10905642 ER -