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Cited by 85Emergency and Acute Care StudiesPrimary Care and Health OutcomesTrauma and Emergency Care Studies

Modeling factors influencing the demand for emergency department services in ontario: a comparison of methods

Open access
Moineddin, Rahim, Meaney, Christopher, Agha, Mohammad, Zagorski, Brandon, Glazier, Richard Henry·2011·BMC Emergency Medicine
DOI 10.1186/1471-227x-11-13PMC PMC3175194
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Abstract

Background: Emergency departments are medical treatment facilities, designed to provide episodic care to patients suffering from acute injuries and illnesses as well as patients who are experiencing sporadic flare-ups of underlying chronic medical conditions which require immediate attention. Supply and demand for emergency department services varies across geographic regions and time. Some persons do not rely on the service at all whereas; others use the service on repeated occasions. Issues regarding increased wait times for services and crowding illustrate the need to investigate which factors are associated with increased frequency of emergency department utilization. The evidence from this study can help inform policy makers on the appropriate mix of supply and demand targeted health care policies necessary to ensure that patients receive appropriate health care delivery in an efficient and cost-effective manner. The purpose of this report is to assess those factors resulting in increased demand for emergency department services in Ontario. We assess how utilization rates vary according to the severity of patient presentation in the emergency department. We are specifically interested in the impact that access to primary care physicians has on the demand for emergency department services. Additionally, we wish to investigate these trends using a series of novel regression models for count outcomes which have yet to be employed in the domain of emergency medical research. Methods: Data regarding the frequency of emergency department visits for the respondents of Canadian Community Health Survey (CCHS) during our study interval (2003-2005) are obtained from the National Ambulatory Care Reporting System (NACRS). Patients' emergency department utilizations were linked with information from the Canadian Community Health Survey (CCHS) which provides individual level medical, socio-demographic, psychological and behavioral information for investigating predictors of increased emergency department utilization. Six different multiple regression models for count data were fitted to assess the influence of predictors on demand for emergency department services, including: Poisson, Negative Binomial, Zero-Inflated Poisson, Zero-Inflated Negative Binomial, Hurdle Poisson, and Hurdle Negative Binomial. Comparison of competing models was assessed by the Vuong test statistic. Results: The CCHS cycle 2.1 respondents were a roughly equal mix of males (50.4%) and females (49.6%). The majority (86.2%) were young-middle aged adults between the ages of 20-64, living in predominantly urban environments (85.9%), with mid-high household incomes (92.2%) and well-educated, receiving at least a high-school diploma (84.1%). Many participants reported no chronic disease (51.9%), fell into a small number (0-5) of ambulatory diagnostic groups (62.3%), and perceived their health status as good/excellent (88.1%); however, were projected to have high Resource Utilization Band levels of health resource utilization (68.2%). These factors were largely stable for CCHS cycle 3.1 respondents. Factors influencing demand for emergency department services varied according to the severity of triage scores at initial presentation. For example, although a non-significant predictor of the odds of emergency department utilization in high severity cases, access to a primary care physician was a statistically significant predictor of the likelihood of emergency department utilization (OR: 0.69; 95% CI OR: 0.63-0.75) and the rate of emergency department utilization (RR: 0.57; 95% CI RR: 0.50-0.66) in low severity cases. Conclusion: Using a theoretically appropriate hurdle negative binomial regression model this unique study illustrates that access to a primary care physician is an important predictor of both the odds and rate of emergency department utilization in Ontario. Restructuring primary care services, with aims of increasing access to undersupplied populations may result in decreased emergency department utilization rates by approximately 43% for low severity triage level cases.

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  • The remaining care dispersion may be due to lack of timely access to primary care even when patients have a regular family physician, and to a preference for timely access for minor health needs over seeing their regular provider.

    “This may be due to lack of timely access to primary care even when patients have a regular family physician, and to a preference for timely access for minor health needs over seeing their regular provider [24, 92, 93].”

    From Improved access to and continuity of primary care after attachment to a family physician: longitudinal cohort study on centralized waiting lists for unattached patients in Quebec, Canada (2022) · cites this paper as [93]

    The Background (page unavailable) says that people who can access primary care may choose the emergency department for its convenience and ease of access. The Discussion (page unavailable) links access to a family doctor with fewer less-urgent emergency visits. The paper does not establish that patients with a regular family physician lacked timely appointments or preferred emergency care specifically for minor needs over seeing that physician. (LLM, conf=0.82)

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Authors
Moineddin, R., Meaney, C., Agha, M., Zagorski, B., & Glazier, R. H.
Affiliations
  • University of Toronto (CA)
  • St. Michael's Hospital (CA)
  • Institute for Clinical Evaluative Sciences (CA)
Corresponding author
Moineddin, Rahim
ORCID
Venue
BMC Emergency Medicine
Publisher
Springer Science and Business Media LLC
Published
2011-08-19
Volume
11
Issue
1
Pages
13-13
ISSN
1471-227X (ISSN-L)
DOI
10.1186/1471-227x-11-13
PMC
PMC3175194
OpenAlex
W2050674998
Cited by
85
References
26
Citations by year
2026: 6 · 2025: 3 · 2024: 7 · 2023: 5 · 2022: 9 · 2021: 8 · 2020: 8 · 2019: 5 · 2018: 6 · 2017: 6 · 2016: 5 · 2015: 5 · 2014: 4 · 2013: 4 · 2012: 3
FWCI
4.07
Type
journal article
Language
en
Open access
Licence
Locations
  • BMC Emergency Medicine (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • TSpace (University of Toronto) (submittedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
  • Institute for Clinical Evaluative Sciences
  • Ontario Ministry of Health and Long-Term Care
Topics
  • Health Sciences › Medicine › Emergency Medicine › Emergency and Acute Care Studies
  • Health Sciences › Health Professions › General Health Professions › Primary Care and Health Outcomes
  • Health Sciences › Medicine › Emergency Medicine › Trauma and Emergency Care Studies
Keywords
emergency department utilization, zero-inflated models, hurdle models, Poisson regression, negative binomial regression, primary care access, emergency department overcrowding, health care demand, Ontario, Canadian Community Health Survey, model comparison, health policy, waiting time, chronic disease, socioeconomic factors, urban-rural differences
MeSH terms
Adult, Aged, Aged, 80 and over, Emergencies, Emergency Service, Hospital, Female, Health Services Accessibility, Health Services Needs and Demand, Humans, Male, Middle Aged, Ontario, Regression Analysis, Socioeconomic Factors, Models, Organizational, Young Adult

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