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BMC Health Services Research
Published in: BMC Health Services Research 1/2015

Open Access 01-12-2015 | Research article

Demographic and clinical predictors of unplanned hospital utilisation among chronically ill patients: a prospective cohort study

Authors: Kylie-Ann Mallitt, Patrick Kelly, Natalie Plant, Tim Usherwood, James Gillespie, Steven Boyages, Stephen Jan, Stephen Leeder

Published in: BMC Health Services Research | Issue 1/2015

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Abstract

Background

In urban Australia, patients with serious and continuing illnesses make frequent use of hospital emergency department (ED) services. However, the risk factors for hospital utilisation among the broad population of people with chronic illness are not well known. The aim of this study was to assess the predictors of hospital utilisation (either inpatient admissions or ED visits) in a cohort of 308 patients with chronic illness.

Methods

We studied patients with serious and continuing chronic illnesses presenting to an ED in a large periurban hospital in western Sydney, Australia, between 2010 and 2013. ED presentations and hospital admissions were observed over two years. Multivariate negative-binomial regression analyses were used to identify risk factors for the number of presentations to hospital.

Results

The main risk factors for hospital utilisation were having a live-in carer, and a history of hospital utilisation. Having a live-in carer was associated with an increase in number of ED presentations by 88% (RR 1.88; 95% CI 1.41-2.51), and of admissions by 116% (RR 2.16; 95% CI 1.61-2.92). Seventy-seven percent of hospital utilisation in the cohort was attributable to carer status. Each additional ED presentation that a person had in the 12 months prior to the study led to an increased risk of an ED presentation in the follow-up period by 6% (RR = 1.06, 95% CI = 1.03-1.08). Between 20% and 25% of variability in hospital utilisation in the cohort was attributable to the number of hospital admissions or ED presentations in the previous 12 months.

Conclusions

Patients with a live-in carer and with a history of hospital utilisation are at high risk for future hospital use.
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Metadata
Title
Demographic and clinical predictors of unplanned hospital utilisation among chronically ill patients: a prospective cohort study
Authors
Kylie-Ann Mallitt
Patrick Kelly
Natalie Plant
Tim Usherwood
James Gillespie
Steven Boyages
Stephen Jan
Stephen Leeder
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2015
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-015-0789-0

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