Factors associated with chronic frequent emergency department utilization in a population with diabetes living in metropolitan areas: a population-based retrospective cohort study
Open accessAbstract
BACKGROUND: A small proportion of patients utilizes a disproportionately large amount of emergency department (ED) resources. Being able to properly identify chronic frequent ED users, i.e. frequent ED users over a multiple-year period, would allow healthcare professionals to intervene before it occurs and, if possible, redirect these patients to more appropriate health services. The objective of this study was to explore the factors associated with chronic frequent ED utilization in a population with diabetes. METHODS: A population-based retrospective cohort study using administrative data was conducted on 62,316 patients with diabetes living in metropolitan areas of Quebec (Canada), having visited an ED during 2006, and still alive in 31 December 2009. The dependant variable was being a chronic frequent ED user, defined as having at least 3 ED visits per year during three consecutive years (2007-2009). Independent variables, measured during 2006, included age, sex, neighbourhood deprivation, affiliation to a general practitioner, and number of physical and mental health comorbidities. Logistic regression and tree-based method were used to identify factors associated with chronic frequent ED use. RESULTS: A total of 2.6% of the cohort (patients with diabetes and at least one ED visit in 2006) was identified as chronic frequent ED users. These patients accounted for 16% of all ED visits made by the cohort during follow-up. The cumulative effect of a high illness burden combined with mental health disorders was associated with an increased risk of chronic frequent ED use. CONCLUSIONS: Interventions must target the population at higher risk of becoming chronic frequent ED users and should be designed to manage the complex interaction between high illness burden and mental health.
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Past ED visit frequency emerged as the strongest predictor, consistent with literature on recurrent acute care utilization and likely reflecting underlying health instability, insufficient outpatient follow-up, and barriers to primary care access.
“Past ED visit frequency emerged as the strongest predictor, consistent with literature on recurrent acute care utilization and likely reflecting underlying health instability, insufficient outpatient follow-up, and barriers to primary care access [2,9].”
From Machine learning-driven risk prediction for post-hospitalization diabetes case management: Integrating clinical and social determinants of health (2026) · cites this paper as [2]
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Experimental — accuracy not yet measuredPatients with diabetes are at higher risk of hospital admissions and frequent ED visits, driven by comorbidities such as heart failure, chronic kidney disease, and poor glycemic control.
“Patients with diabetes are at higher risk of hospital admissions and frequent emergency department (ED) visits [2], driven by comorbidities such as heart failure, chronic kidney disease, and poor glycemic control [3].”
From Machine learning-driven risk prediction for post-hospitalization diabetes case management: Integrating clinical and social determinants of health (2026) · cites this paper as [2]
The Background describes patients with diabetes as high health care users, and the Results report frequent ED use within the diabetes cohort. The paper does not establish that patients with diabetes have a higher risk of hospital admission or frequent ED visits than patients without diabetes. The comorbidities clause is attached to a different citation and is not assessed here. (LLM, conf=0.83)
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Impact of Primary Health Care Reforms in Quebec’s Health Care System: A Systematic Review
Lalonde, J.-D., Gartner, J., Bergeron, F., Tànfani, E., & Landa, P. (2026) · Healthcare · doi:10.3390/healthcare14203373
- Authors
- Hudon, C., Courteau, J., Krieg, C., & Vanasse, A.
- Affiliations
- Université de Sherbrooke (CA)
- Centre de recherche du CHUS (CA)
- Corresponding author
- Hudon, Catherine
- Venue
- BMC Health Services Research
- Published
- 2017-08-04
- Volume
- 17
- Issue
- 1
- Pages
- 525-525
- ISSN
- 1472-6963 (ISSN-L)
- PMC
- PMC5544976
- OpenAlex
- W2744126565
- Cited by
- 32
- References
- 42
- Citations by year
- 2026: 3 · 2025: 3 · 2024: 3 · 2023: 5 · 2022: 2 · 2021: 6 · 2020: 7 · 2019: 3
- FWCI
- 3.48
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- BMC Health Services Research (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Canadian Institutes of Health Research (CIHR #204982)
- Topics
- Health Sciences › Medicine › Emergency Medicine › Emergency and Acute Care Studies
- Health Sciences › Medicine › Epidemiology › Chronic Disease Management Strategies
- Health Sciences › Health Professions › General Health Professions › Primary Care and Health Outcomes
- Keywords
- diabetes mellitus, emergency department utilization, neighborhood disadvantage, psychiatric comorbidity, somatic comorbidity, disease burden, healthcare resource utilization, metropolitan areas
- MeSH terms
- Adult, Aged, Mental Disorders, Diabetes Mellitus, Emergency Service, Hospital, Female, Health Services, Hospitals, Urban, Humans, Male, Mental Health, Middle Aged, Patient Acceptance of Health Care, Quebec, Residence Characteristics, Retrospective Studies, Urban Health, Comorbidity, Logistic Models
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