Frequent-users of Emergency Department: a mixed-methods observational retrospective study in Emilia-Romagna (Italy).
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Supplementary Files

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Keywords

Health Services Research
Disease Prevention
Levels of Health
Social Determinants of Health. Investigación sobre Servicios de Salud
Prevención de Enfermedades
Niveles de Salud
Determinantes Sociales de la Salud. Pesquisa sobre Serviços de Saúde
Prevenção de Doenças
Níveis de Saúde
Determinantes Sociais de Saúde.

Abstract

Background. The overcrowding of Emergency Departments (EDs) represents a major concern in Italy. Frequent users (FUs) contribute to overcrowding, wasting health care resources. Objective. To describe the characteristics of FUs and to evaluate the reliability of the ED information systems. Design. An observational single-centre retrospective study.Methods. A quali-quantitative analysis of medical records from FU admissions to the ED in a 15-month period at a Teaching Hospital in Italy.
Results. 1,766 FUs accessed the ED, totalizing 11,842 admissions. The green and white codes were the most frequent ones (n=9,065; 76.5%). Acute conditions prevailed among the reasons for admission. The qualitative analysis showed that FUs were mainly burdened with chronic conditions and highlighted the role of the ED in managing them. Discussion. FUs suffer from mltiple and chronic conditions, which are not captured by the ED’s information system.Conclusions. The adoption of a patient-centred approach oriented towards chronic conditions could result in richer information and better management of FUs.

https://doi.org/10.17665/1676-4285.20206249
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References

Ministero della Salute - Agenzia Nazionale per i Servizi Sanitari Regionali. Programma Nazionale Esiti – PNE. http://pne2017.agenas.it/

Hoot NR, Aronsky D. Systematic review of emergency department crowding: causes, effects, and solutions. Ann Emerg Med 2008; 52(2): 126–36. doi: 10.1016/j.annemergmed.2008.03.014 PMID: 18433933

Asplin BR, Magid DJ, Rhodes KV, Solberg LI, Lurie N, Camargo CA. A conceptual model of emergency department crowding. Ann Emerg Med 2003; 42(2): 173–80.

Ferro S, Montella MT, eds. Linee di indirizzo per la gestione del sovraffollamento nelle strutture di pronto soccorso della regione Emilia-Romagna. Regione Emilia-Romagna, 2016.

Ameri M, Cremonesi P, Montefiori M. The effects of inappropriate emergency department use. Study Economics 2011; 105(3): 123–36.

Uscher-Pines L, Pines J, Kellermann A, Gillen E, Mehrotra A. Deciding to Visit the Emergency Department for Non-Urgent Conditions: A Systematic Review of the Literature. Am J Manag Care 2013; 19(1): 47–59.

LaCalle E, Rabin E. Frequent Users of Emergency Departments: The Myths, the Data, and the Policy Implications. Ann Emerg Med 2010; 56(1): 42–8.

Leporatti L, Ameri M, Trinchero C, Orcamo P, Montefiori M. Targeting frequent users of emergency departments: Prominent risk factors and policy implications. Health Policy (New York) 2016; 120(5): 462–70.

World Health Organization (WHO). Innovative Care for Chronic Conditions: building blocks for action: global report. Geneva: WHO, 2002. ISBN: 9241590173.

Quaranta I. Antropologia medica. I testi fondamentali. Milano, Raffaello Cortina, 2006.

World Health Organization (WHO) Commission on Social Determinants of Health. Closing the gap in a generation: Health equity through action on the social determinants of health. Geneva, 2008.

Cook LJ, Knight S, Junkins Jr EP, Mann NC, Dean JM, Olson LM. Repeat patients to the emergency department in a statewide database.Acad Emerg Med 2004; 11(3): 256–63.

Grover CA, Crawford E, Close RJH. The Efficacy of Case Management on Emergency Department Frequent Users: An Eight-Year Observational Study. J Emerg Med. 2016; 51(5): 595–604.

Starfield B. Is Patient-Centered Care the Same as Person-Focused Care? Perm J 2011; 15(2): 63-9.

Shaw I. Doctors, "dirty work" patients, and "revolving doors". Qual Health Res. 2004 Oct;14(8):1032-45.

Lawrence D, Hancock KJ, Kisely S. The gap in life expectancy from preventable physical illness in psychiatric patients in Western Australia: retrospective analysis of population based registers. BMJ 2013; 346: f2539.

Tange H, Nagykaldi Z, De Maeseneer J. Towards an overarching model for electronic medical-record systems, including problem-oriented, goal-oriented, and other approaches. Eur J Gen Pract. 2017 Dec;23(1):257-260.

Pereira Gray DJ, Sidaway-Lee K, White E, Thorne A, Evans PH. Continuity of care with doctors—a matter of life and death? A systematic review of continuity of care and mortality. BMJ Open 2018; 8(6): e021161.

Gibbons DC, Bindman AB, Soljak MA, Millett C, Majeed A. Defining primary care sensitive conditions: A necessity for effective primary care delivery? J R Soc Med 2012; 105(10): 422–8.

Caminal J, Starfield B, Sánchez E, Casanova C, Morales M. The role of primary care in preventing ambulatory care sensitive conditions. Eur J Public Health 2004; 14(3): 246–51.