Document Type

Article

Publication Date

2016

DOI

10.1371/journal.pone.0147116

Publication Title

PLoS ONE

Volume

11

Issue

1

Pages

1-18

Abstract

Objectives
First, to test a model of the drivers of frequent emergency department utilization conceptualized as falling within predisposing, enabling, and need dimensions. Second, to extend the model to include social networks and service quality as predictors of frequent utilization. Third, to illustrate the variation in thresholds that define frequent utilization in terms of the number of emergency department encounters by the predictors within the model.

Data Source
Primary data collection over an eight week period within a level-1 trauma urban hospital's emergency department.

Study Design
Representative randomized sample of 1,443 adult patients triaged ESI levels 4'5. Physicians and research staff interviewed patients as they received services. Relationships with the outcome variable, utilization, were tested using logistic regression to establish odds-ratios.

Principal
Findings 70.6 percent of patients have two or more, 48.3 percent have three or more, 25.3 percent have four or more, and 14.9 percent have five or more emergency department visits within 12 months. Factors associated with frequent utilization include gender, race, poor mental health, mental health drugs, prescription drug abuse, social networks, employment, perceptions of service quality, seriousness of condition, persistence of condition, and previous hospital admittance.

Conclusions
Interventions targeting associated factors will change global emergency department encounters, although the mutability varies. Policy interventions to address predisposing factors such as substance abuse or access to mental health treatment as well as interventions that speak to enabling factors such as promoting the resiliency of social networks may result in decreased frequency of emergency department utilization.

Original Publication Citation

Behr, J.G., & Diaz, R. (2016). Emergency department frequent utilization for non-emergent presentments: Results from a regional urban trauma center study. PLoS ONE, 11(1), 1-18. doi: 10.1371/journal.pone.0147116

Download

Share

COinS