Factors associated with frequent use of emergency services in a medical center

Overuse of emergency department (ED) services can result in overcrowding and a substantial increase of health care cost. The purpose of this study was to characterize frequent ED users and to identify the factors associated with frequent ED use in a hospital in Taiwan.

This retrospective study used Andersen's Behavioral Model of Health Service Use as a framework. Frequent ED users (>/= 4 visits/year) and infrequent ED users (< 4 visits/ year) were selected randomly from patients visiting the adult ED of a medical center in central Taiwan from October 1, 2000 to September 30, 2001. Telephone interviews were completed for 200 frequent users and 600 infrequent users. Logistic regression analysis was performed to identify factors associated with frequent ED use.

Frequent ED users comprised 3.5% of total ED patients, accounting for 14.3% of the ED visits. Significant factors associated with frequent ED use were: a regular source of care [odds ratio (OR), 2.79; 95% confidence interval (CI), 1.63 to 4.79], alcoholism (OR, 19.4; 95% CI, 3.84 to 98.0), high outpatient clinic use (OR, 2.66; 95% CI, 1.72 to 4.11), previous hospitalization (OR, 3.06; 95% CI, 1.94 to 4.82), chronic disease (OR, 3.07; 95% CI, 1.78 to 5.29), cancer (OR, 4.16; 95% CI, 1.29 to 13.4), gastrointestinal disease (OR, 6.28; 95% CI, 1.95 to 20.2), cardiovascular disease (OR, 8.41; 95% CI, 2.51 to 28.1), pulmonary disease (OR, 4.21; 95% CI, 1.04 to 17.1), low level of emergency (OR, 5.43; 95% CI, 3.40 to 8.68), and dissatisfaction with treatment outcome (OR, 2.62; 95% CI, 1.32 to 5.20).

Frequent ED users were responsible for a disproportionate number of the total ED visits. Andersen's "need factors" were strongly associated with frequent ED use, while the investigated predisposing factors were not significant. Most patients who visited the ED had a low level of emergency. These findings suggest that implementation of an integrated delivery system may decrease ED use.