Emergency admission: Who is affected?

Peter T. Donnan, Ph.D., of the University of Dundee, Scotland, and colleagues studied 90,522 residents of Tayside, Scotland, where each individual who visits a general practitioner is given a 10-digit identifier. The participants had to be at least 40 years old when they entered the study between 1996 and 2004 and at least three years of data available on hospital use and drug prescribing and were followed for at least one year

At least they identified 35 such parameters that were used to derive the probability of emergency admission within the next year, expressed as a percentage. But finally the summerized the most expressiv characteristics in a short list. They found that those who were hospitalized tended to:

“As an example, consider a man aged 72 years and is from a highly deprived area; has previous emergency admissions, eight previous admissions and 106 total bed-days in the previous three years; and is in receipt of hypertension and heart failure drugs, nitrates and calcium channel blockers, respiratory drugs, anxiolytics, antidepressants, analgesics and antibacterials: the absolute risk of admission in the next year is 52.8 percent,” the authors write in the current issue of Archives of Internal Medicine. On the other hand, a 50-year-old woman from an affluent area with no previous emergency admissions and one previous hospital admission with a one-day stay who takes ulcer-healing drugs, diuretics and antibiotics would have a 2.4 percent risk of emergency admission in the next year.
 

Stratifying individuals by risk to target health care may help reverse the trend of increasing emergency hospital admissions, according to background information in the article. Several models have been previously developed to identify those at risk. However, most have focused on those older than 65 years or those who have already experienced multiple emergency admissions. “These algorithms clearly leave out of consideration the important group of people at high risk who are younger than 65 years and those who have never experienced an emergency admission but are likely to experience an emergency admission in the future,” the authors write.
 
The model “provides a useful tool for the individual clinician in face-to-face consultation as well as the general practice as a whole, and for health insurers, policy makers and planners at the health board level faced with the increasing prevalence of hospital use,” the authors conclude. “This work has immediate relevance to developing policy and service reorganization, as well as informing future intervention studies of different models of case management.”