Improvement in Asthma Medication Ratio Performance Is Associated With Decreased Rates of Asthma-Coded Emergency Department Visits Over Time

Repeated emergency department visits have become a serious challenge worldwide. Despite prior research indicating that laboratory results may provide early alerts about such patients on their upcoming adverse events, few studies have examined their role as a critical indicator of the stability of a patient’s medical condition over time. We model and analyze the developmental trajectories of patients’ creatinine levels, a key laboratory marker of serious illness, as a potential risk stratification mechanism across many emergency department visits. We apply group-based statistical methodology to electronic health record data of 70,385 patients, with 3–15 emergency department visits, to identify and profile these trajectories for the entire population, for males and for females. Results reveal three distinct creatinine-based trajectory groups over time with significantly differing characteristics that may enable targeted interventions for each group. Future research will incorporate additional disease markers to identify longitudinal factors leading to repeated emergency department visits.

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Exploratory Research on the Health and Social Outcomes of Public Housing

International Journal for Population Data Science ◽

10.23889/ijpds.v4i3.1229 ◽

2019 ◽

Vol 4 (3) ◽

Author(s):

Mark Smith ◽

Aynslie Hinds ◽

Heather Prior ◽

Dan Chateau

Keyword(s):

Emergency Department ◽

Criminal Justice ◽

Criminal Justice System ◽

Public Housing ◽

Administrative Data ◽

Justice System ◽

Emergency Department Visits ◽

Social Outcomes ◽

The Impact ◽

Over Time

BackgroundUnder the National Housing Strategy, the Canadian government will make historic investments in housing over the next decade. The Canadian Mortgage and Housing Corporation is leading a research strategy to evaluate the impact of these investments. As part of this initiative, the Manitoba Center for Health Policy is conducting a pilot study to determine whether administrative data can be used to assess impacts, specifically looking at health, education and involvement in the justice system. ApproachUsing administrative data we tested for changes in healthcare use and justice involvement in the two years before and after a cohort of individuals moved into public housing. Additionally, to determine if changes in the outcomes over time were unique to public housing, we included a matched comparison group of individuals who did not reside in public housing. GLM with generalized estimating equations tested for differences over time and between cohorts in the number of hospitalizations, inpatient days, emergency department visits, and contacts with the criminal justice system. The data were modeled using a Poisson distribution (rate ratio, RR). Results Compared to the matched cohort, individuals accepted into public housing showed a significant decline in number of hospitalizations (pre RR=1.58 (1.53, 1.63), post RR=1.23 (1.19, 1.27), days in hospital (pre RR=1.66 (1.64, 1.68), post RR=1.24 (1.23, 1.26) and visits to the emergency department (pre RR=1.57 (1.52, 1.62), post RR=1.42 (1.38, 1.47). A trend towards fewer involvements with the criminal justice system was also observed (pre RR=1.37 (1.32, 1.43), post RR=1.28 (1.22, 1.34). No significant differences were noted for total respiratory morbidity or high school grades. ConclusionAdministrative data show good potential to be used for the evaluation of public housing impacts on a wide range of health and social outcomes. Additional indicator comparisons will be reported at the conference.

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Trends in sports-related emergency department visits in the Netherlands, 2009–2018

BMJ Open Sport & Exercise Medicine ◽

10.1136/bmjsem-2020-000811 ◽

2020 ◽

Vol 6 (1) ◽

pp. e000811

Author(s):

Branko F Olij ◽

Ellen Kemler ◽

Huib Valkenberg ◽

Christine Stam ◽

Vincent Gouttebarge ◽

...

Keyword(s):

Emergency Department ◽

The Netherlands ◽

Time Trends ◽

Emergency Department Visits ◽

Mountain Bike ◽

Sports Activity ◽

Ed Visits ◽

Sports Activities ◽

Over Time ◽

Mountain Bike Racing

ObjectivesWe aim to describe time trends of severe sports-related emergency department (ED) visits in the Netherlands, from 2009 to 2018.MethodsData were extracted from the Dutch Injury Surveillance System by age, gender, sports activity and injury diagnosis, from 2009 to 2018. Absolute numbers and time trends of severe sports-related ED visits were calculated.ResultsBetween 2009 and 2018, the overall numbers of severe sports-related ED visits in the Netherlands have significantly decreased by 14% (95% CI −19% to −9%). This trend was seen among men (−12%; 95% CI −18% to −6%), women (−19%; 95% CI −26% to −11%) and individuals aged 18–34 years (−19%; 95% CI −28% to −10%). The number of ED visits has significantly decreased over time in soccer (−15%; 95% CI −24% to −6%), ice-skating (−80%; 95% CI −85% to −73%) and in inline/roller skating (−38%; 95% CI −55% to −15%). This was not the case in road cycle racing (+135%; 95% CI +85% to +198%) and mountain bike racing (+80%; 95% CI +32% to+146%). In terms of sports injury diagnoses, the number of fractured wrists (−15%; 95% CI −24% to −5%), fractured hands (−37%; 95% CI −49% to −21%), knee distortions (−66%; 95% CI −74% to −55%), and fractured lower legs (−38%; 95% CI −55% to −14%) significantly decreased over time.ConclusionOur study shows a promising reduction in the number of severe sports-related ED visits across most age groups and sports activities. As the number of ED visits increased in road cycle and mountain bike racing, it is important to find out what caused these increases. Furthermore, it is essential to determine trends in exposure hours and to evaluate and implement injury prevention programmes specific for these sports activities.

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Socioeconomic and Geographic Disparities in Emergency Department Visits due to Alcohol in Ontario: A Retrospective Population-level Study from 2003 to 2017: Disparités Socio-Économiques et Géographiques Dans les Visites au Service D’urgence en raison de L’alcool en Ontario: Une étude Rétrospective Dans la Population, de 2003 à 2017

The Canadian Journal of Psychiatry ◽

10.1177/07067437211027321 ◽

2021 ◽

pp. 070674372110273

Author(s):

Daniel Myran ◽

Amy Hsu ◽

Elizabeth Kunkel ◽

Emily Rhodes ◽

Haris Imsirovic ◽

...

Keyword(s):

Emergency Department ◽

Low Income ◽

Population Level ◽

Emergency Department Visits ◽

Income Quintile ◽

Urban Settings ◽

Rural Settings ◽

Ed Visits ◽

Over Time ◽

Age And Sex

Objective: While the overall health system burden of alcohol is large and increasing in Canada, little is known about how this burden differs by sociodemographic factors. The objectives of this study were to assess sociodemographic patterns and temporal trends in emergency department (ED) visits due to alcohol to identify emerging and at-risk subgroups. Methods: We conducted a retrospective population-level cohort study of all individuals aged 10 to 105 living in Ontario, Canada. We identified ED visits due to alcohol between 2003 and 2017 using defined International Classification of Diseases, 10th edition, codes from a pre-existing indicator. We calculated annual age- and sex-standardized, and age- and sex-specific rates of ED visits and compared overall patterns and changes over time between urban and rural settings and income quintiles. Results: There were 829,662 ED visits due to alcohol over 15 years. Rates of ED visits due to alcohol were greater for individual living in the lowest- compared to the highest-income quintile neighbourhoods, and disparities (rate ratio lowest to highest quintile) increased with age from 1.22 (95% CI, 1.19 to 1.25) in 15- to 18-year-olds to 4.17 (95% CI, 4.07 to 4.28) in 55- to 59-year-olds. Rates of ED visits due to alcohol were significantly greater in rural settings (56.0 per 10,000 individuals, 95% CI, 55.7 to 56.4) compared to urban settings (44.8 per 10,000 individuals, 95% CI, 44.7 to 44.9), particularly for young adults. Increases in rates of visits between 2003 and 2017 were greater in rural versus urban settings (82 vs. 68% increase in age- and sex-standardized rates) and varied across sociodemographic subgroups with the largest annual increases in rates of visits in young (15 to 29) low-income women (6.9%, 95%CI, 6.7 to 7.3) and the smallest increase in older (45 to 59) high-income men (2.7, 95%CI, 2.4 to 3.0). Conclusion: Alcohol harms display unique patterns with the highest burden in rural and lower-income populations. Rural–urban and income-based disparities differ by age and sex and have increased over time, which offers an imperative and opportunity for further interventions by clinicians and policy makers.

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Temporal Trends of Emergency Department Visits of Patients with Atrial Fibrillation: A Nationwide Population-Based Study

Journal of Clinical Medicine ◽

10.3390/jcm9051485 ◽

2020 ◽

Vol 9 (5) ◽

pp. 1485

Author(s):

So-Ryoung Lee ◽

Eue-Keun Choi ◽

Seo-Young Lee ◽

Euijae Lee ◽

Kyung-Do Han ◽

...

Keyword(s):

Atrial Fibrillation ◽

Emergency Department ◽

Temporal Trends ◽

Population Based ◽

Emergency Department Visits ◽

Cross Sectional ◽

Ed Visits ◽

Management Approaches ◽

Sectional Analysis ◽

Over Time

We aimed to describe temporal trends in emergency department (ED) visits of patients with atrial fibrillation (AF) over 12 years. A repeated cross-sectional analysis of ED visits in AF patients using the Korean nationwide claims database between 2006 and 2017 were conducted. We identified AF patients who had ≥1 ED visits. The incidence of ED visits among total AF population, cause of ED visit, and clinical outcomes were evaluated. During 12 years, the annual numbers of AF patients who attended ED at least once a year continuously increased (40,425 to 99,763). However, the annual incidence of ED visits of AF patients was stationary at about 30% because the number of total AF patients also increased during the same period. The most common cause of ED visits was cerebral infarction. Although patients had a higher risk profile over time, the 30-day and 90-day mortality after ED visit decreased over time. ED visits due to ischemic stroke, intracranial hemorrhage, and myocardial infarction decreased, whereas ED visits due to AF, gastrointestinal bleeding, and other major bleeding slightly increased among total AF population over 12 years. A substantial proportion of AF patients attended ED every year, and the annual numbers of AF patients who visited the ED significantly increased over 12 years. Optimized management approaches in a holistic and integrated manner should be provided to reduce ED visits of AF patients.

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