scholarly journals Factors associated with chronic frequent emergency department utilization in a population with diabetes living in metropolitan areas: a population-based retrospective cohort study

2017 ◽  
Vol 17 (1) ◽  
Author(s):  
Catherine Hudon ◽  
Josiane Courteau ◽  
Cynthia Krieg ◽  
Alain Vanasse
Keyword(s):  
Emergency Department ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Metropolitan Areas ◽  
Population Based ◽  
Emergency Department Utilization ◽  
Factors Associated

The occurrence and timing of delirium in acute care hospitalizations in the last year of life: A population-based retrospective cohort study

2020 ◽  
Vol 34 (8) ◽  
pp. 1067-1077
Author(s):  
Colleen Webber ◽  
Christine L Watt ◽  
Shirley H Bush ◽  
Peter G Lawlor ◽  
Robert Talarico ◽  
...  
Keyword(s):  
Cohort Study ◽  
Confidence Interval ◽  
Acute Care ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Prevalence Ratio ◽  
Acute Care Hospitals ◽  
Population Based ◽  
Care Hospital ◽  
Factors Associated

Background: Delirium is a distressing neurocognitive disorder that is common among terminally ill individuals, although few studies have described its occurrence in the acute care setting among this population. Aim: To describe the prevalence of delirium in patients admitted to acute care hospitals in Ontario, Canada, in their last year of life and identify factors associated with delirium. Design: Population-based retrospective cohort study using linked health administrative data. Delirium was identified through diagnosis codes on hospitalization records. Setting/participants: Ontario decedents (1 January 2014 to 31 December 2016) admitted to an acute care hospital in their last year of life, excluding individuals age of <18 years or >105 years at admission, those not eligible for the provincial health insurance plan between their hospitalization and death dates, and non-Ontario residents. Results: Delirium was recorded as a diagnosis in 8.2% of hospitalizations. The frequency of delirium-related hospitalizations increased as death approached. Delirium prevalence was higher in patients with dementia (prevalence ratio: 1.43; 95% confidence interval: 1.36–1.50), frailty (prevalence ratio: 1.67; 95% confidence interval: 1.56–1.80), or organ failure–related cause of death (prevalence ratio: 1.23; 95% confidence interval: 1.16–1.31) and an opioid prescription (prevalence ratio: 1.17; 95% confidence interval: 1.12–1.21). Prevalence also varied by age, sex, chronic conditions, antipsychotic use, receipt of long-term care or home care, and hospitalization characteristics. Conclusion: This study described the occurrence and timing of delirium in acute care hospitals in the last year of life and identified factors associated with delirium. These findings can be used to support delirium prevention and early detection in the hospital setting.

scholarly journals Indirect impact of the COVID-19 pandemic on emergency department presentations and hospital admissions for urgent early pregnancy conditions: a population-based retrospective cohort study

2021 ◽  
Author(s):  
Lisa Hui ◽  
Wanyu Chu ◽  
Elizabeth McCarthy ◽  
Mary McCarthy ◽  
Paddy Moore ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cohort Study ◽  
Early Pregnancy ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Linear Prediction ◽  
Hospital Admissions ◽  
Population Based ◽  
Termination Of Pregnancy ◽  
The Impact

Objective: To compare emergency department (ED) presentations and hospital admissions for urgent early pregnancy conditions in Victoria before and after the onset of COVID-19 lockdown on 31 March 2020. Design: Population-based retrospective cohort study Setting: Australian state of Victoria Population: Pregnant women presenting to emergency departments or admitted to hospital Methods: We obtained state-wide hospital separation data from the Victorian Emergency Minimum Dataset and the Victorian Admitted Episodes Dataset from January 1, 2018, to October 31, 2020. A linear prediction model based on the pre-COVID period was used to identify the impact of COVID restrictions. Main outcome measures: Monthly ED presentations for miscarriage and ectopic pregnancy, hospital admissions for termination of pregnancy, with subgroup analysis by region, socioeconomic status, disease acuity, hospital type. Results: There was an overall decline in monthly ED presentations and hospital admissions for early pregnancy conditions in metropolitan areas where lockdown restrictions were most stringent. Monthly ED presentations for miscarriage during the COVID period were consistently below predicted, with the nadir in April 2020 (790 observed vs 985 predicted, 95% CI 835-1135). Monthly admissions for termination of pregnancy were also below predicted throughout lockdown, with the nadir in August 2020 (893 observed vs 1116 predicted, 95% CI 905-1326). There was no increase in ED presentations for complications following abortion, ectopic or molar pregnancy during the COVID period. Conclusions: Fewer women in metropolitan Victoria utilized hospital-based care for early pregnancy conditions during the first seven months of the pandemic, without any observable increase in maternal morbidity.

Effects of Rurality and Geographical Distance on Unplanned Emergency Department Utilization for Children With Asthma: A Population Level Retrospective Cohort Study

2020 ◽  
pp. 084456212097424
Author(s):  
Jennifer Wilson ◽  
Laurie Gedcke-Kerr ◽  
Kevin Woo ◽  
Pilar Camargo Plazas ◽  
Joan Tranmer
Keyword(s):  
Emergency Department ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Population Level ◽  
Healthcare Services ◽  
Emergency Department Utilization ◽  
Geographical Distance ◽  
Children With Asthma ◽  
The Impact

Background Asthma is a highly prevalent chronic disease among Ontario children; however, the extent to which rural status and distance are associated with unplanned emergency department (ED) use by this population is largely unknown. Objective To explore the impact of rurality and geographical distance to primary and specialist care services on healthcare utilization by analyzing the use of unplanned ED services. Methods A population level retrospective cohort study of Ontario children ages 5–14 with newly diagnosed asthma was conducted using health administrative data from Institute for Clinical Evaluative Sciences (ICES). Adjusted logistic regression models were used to analyze the association between unplanned ED use with rural status and distance to general practitioner/family physician (GP/FP) and specialist healthcare services, while controlling for confounders. Results In total, 19,732 individuals met the inclusion criteria. Individuals who lived in rural locations (OR 2.00, 95% CI 1.64–2.44) and travelled >50 km to a GP/FP (OR 1.25, 95% CI 1.06–1.48) or specialist (OR 1.20, 95% CI 1.05–1.38) were more likely to utilize an ED. Conclusion Children with asthma utilize healthcare services differently based on rural status and distance to services. To ensure equitable access to care, there is a need to accommodate for these factors in the planning and provision of asthma healthcare services.

Impact of physician-based palliative care delivery models on health care utilization outcomes: A population-based retrospective cohort study

2021 ◽  
pp. 026921632110094
Author(s):  
Catherine R L Brown ◽  
Colleen Webber ◽  
Hsien-Yeang Seow ◽  
Michelle Howard ◽  
Amy T Hsu ◽  
...  
Keyword(s):  
Emergency Department ◽  
Palliative Care ◽  
Cohort Study ◽  
Healthcare Utilization ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Home Visit ◽  
Population Based ◽  
Emergency Department Visits ◽  
Care Model

Background: Increasing involvement of palliative care generalists may improve access to palliative care. It is unknown, however, if their involvement with and without palliative care specialists are associated with different outcomes. Aim: To describe physician-based models of palliative care and their association with healthcare utilization outcomes including: emergency department visits, acute hospitalizations and intensive care unit (ICU) admissions in last 30 days of life; and, place of death. Design: Population-based retrospective cohort study using linked health administrative data. We used descriptive statistics to compare outcomes across three models (generalist-only palliative care; consultation palliative care, comprising of both generalist and specialist care; and specialist-only palliative care) and conducted a logistic regression for community death. Setting/participants: All adults aged 18–105 who died in Ontario, Canada between April 1, 2012 and March 31, 2017. Results: Of the 231,047 decedents who received palliative services, 40.3% received generalist, 32.3% consultation and 27.4% specialist palliative care. Across models, we noted minimal to modest variation for decedents with at least one emergency department visit (50%–59%), acute hospitalization (64%–69%) or ICU admission (7%–17%), as well as community death (36%–40%). In our adjusted analysis, receipt of a physician home visit was a stronger predictor for increased likelihood of community death (odds ratio 9.6, 95% confidence interval 9.4–9.8) than palliative care model (generalist vs consultation palliative care 2.0, 1.9–2.0). Conclusion: The generalist palliative care model achieved similar healthcare utilization outcomes as consultation and specialist models. Including a physician home visit component in each model may promote community death.

Sign in / Sign up

Export Citation Format

Share Document