Profiles of frequent emergency department users with chronic conditions: a latent class analysis.

OBJECTIVES: Frequent emergency department users represent a small proportion of users while cumulating many visits. Previously identified factors of frequent use include high physical comorbidity, mental health disorders, poor socioeconomic status and substance abuse. However, frequent users do not necessarily exhibit all these characteristics and they constitute a heterogeneous population. This study aims to establish profiles of frequent emergency department users in an adult population with chronic conditions. DESIGN: This is a retrospective cohort study using administrative databases. SETTING: All adults who visited the emergency department between 2012 and 2013 (index date) in the province of Quebec (Canada), diagnosed with at least one chronic condition, and without dementia were included. Patients living in remote areas and who died in the year following their index date were excluded. We used latent class analysis, a probability-based model to establish profiles of frequent emergency department users. Frequent use was defined as having five visits or more during 1 year. Patient characteristics included sociodemographic characteristics, physical and mental comorbidities and prior healthcare utilisation. RESULTS: Out of 4 51 775 patients who visited emergency departments at least once in 2012-2013, 13 676 (3.03%) were frequent users. Four groups were identified: (1) 'low morbidity' (n=5501, 40.2%), (2) 'high physical comorbidity' (n=3202, 23.4%), (3) 'injury or chronic non-cancer pain' (n=2313, 19.5%) and (4) 'mental health or alcohol/substance abuse' (n=2660, 16.9%). CONCLUSIONS: The four profiles have distinct medical and socioeconomic characteristics. These profiles provide useful information for developing tailored interventions that would address the specific needs of each type of frequent emergency department users.

Gas discrimination by simultaneous sound velocity and attenuation measurements using uncoated capacitive micromachined ultrasonic transducers.

Chemically functionalized or coated sensors are by far the most employed solution in gas sensing. However, their poor long term stability represents a concern in applications dealing with hazardous gases. Uncoated sensors are durable but their selectivity is poor or non-existent. In this study, multi-parametric discrimination is used as an alternative to selectivity for uncoated capacitive micromachined ultrasonic transducers (CMUTs). This paper shows how measuring simultaneously the attenuation coefficient and the time of flight under different nitrogen mixtures allows to identify hydrogen, carbon dioxide and methane from each other and determine their concentration along with identification of temperature and humidity drifts. Theoretical comparison and specific signal processing to deal with the issue of multiple reflections are also presented. Some potential applications are monitoring of refueling stations, vehicles and nuclear waste storage facilities.

Profiles of Frequent Geriatric Users of Emergency Departments: A Latent Class Analysis.

BACKGROUND/OBJECTIVES: Frequent geriatric users of emergency departments (EDs) represent a complex and heterogeneous population. Identifying their specific subgroups would allow the development of interventions better customized to their needs and characteristics. Thus, this study aimed to develop profiles of frequent geriatric ED users using the individual characteristics of patients. DESIGN: This was a retrospective cohort study. SETTING: Databases from the Régie de l'assurance maladie du Québec (RAMQ) were utilized. PARTICIPANTSThis study included individuals aged 65 years or older living in the community in the Province of Quebec (Canada), who consulted in an ED at least four times in the year after an ED index date (an ED visit, chosen randomly, during an index period of January 1, 2012 to December 31, 2013) and who had received a diagnosis of ambulatory care-sensitive conditions (ACSCs) in the 2 years preceding the index date. MEASUREMENTS: A latent class analysis was used to identify subgroups of frequent geriatric ED users according to their individual characteristics, including ACSC type, dementia, mental health disorders, cancer diagnosis, and comorbidity index. RESULTS: The study cohort consisted of 21,393 frequent geriatric ED users. Four groups of frequent geriatric ED users were identified: people with low comorbidity (39.0%), comprising the individuals with the lowest number of physical and mental health conditions; people with cancer (32.7%); people with pulmonaryand cardiac diseases (18.1%); and people with dementia or mental health disorders (10.2%), composed of individuals with the highest proportion of common and severe mental health disease, as well as dementia. This group accounts for the highest use of overall healthcare services. CONCLUSION: These profiles will be useful in developing customized interventions addressing the needs of each subgroup of frequent geriatric ED users. More research is needed to bridge the remaining gaps, especially regarding the healthiest frequent geriatric users of EDs.

Frequent emergency department use by older adults with ambulatory care sensitive conditions: A population-based cohort study.

AIM: To identify factors associated with frequent emergency department (ED) use among older adults with ambulatory care sensitive conditions. METHODS: This was a retrospective cohort study using databases from the Régie de l'assurance maladie du Québec. We included community-dwelling individuals aged ≥65 years in the Province of Quebec (Canada), who consulted in ED at least once between 2012 and 2013 (index period), and were diagnosed with at least one ambulatory care sensitive condition in the 2 years preceding and including the index date (n = 264 473). We used a multivariate logistic regression model to evaluate the association between independent variables and being a frequent geriatric ED user, defined as four or more visits during the year after the index date. RESULTS: Out of the total study population, 17 332 (6.6%) individuals were considered frequent ED users in the year after the index date, accounting for 38% of ED uses for this period. The main variables associated with frequent geriatric ED use were older age, presence of chronic obstructive pulmonary disorder or diabetes, higher comorbidity index, common mental health disorders, polypharmacy, higher number of past ED and specialist visits, rural residence, and higher material and social deprivation. Dementia was inversely associated with frequent ED use. CONCLUSIONS: Frequent geriatric ED users constitute a complex population whose characteristics need to be managed thoroughly in order to enhance the quality and efficiency of their care. Further studies should address their description in administrative databases so as to combine self-perceived and professionally evaluated variables. Geriatr Gerontol Int 2020; 20: 317-323.