title: Demographic and clinical predictors of unplanned hospital utilisation among chronically ill patients: a prospective cohort study.
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.
authors.affiliation: Menzies Centre for Health Policy, University of Sydney, Sydney, NSW, Australia. k.mallitt@unsw.edu.au.|Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia. k.mallitt@unsw.edu.au.
authors.forename: Kylie-Ann
authors.initials: KA
authors.lastname: Mallitt
authors.affiliation: Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia. p.kelly@sydney.edu.au.
authors.forename: Patrick
authors.initials: P
authors.lastname: Kelly
authors.affiliation: Menzies Centre for Health Policy, University of Sydney, Sydney, NSW, Australia. natalie.plant@sydney.edu.au.
authors.forename: Natalie
authors.initials: N
authors.lastname: Plant
authors.affiliation: Discipline of General Practice, University of Sydney, Sydney, NSW, Australia. tim.usherwood@sydney.edu.au.
authors.forename: Tim
authors.initials: T
authors.lastname: Usherwood
authors.affiliation: Menzies Centre for Health Policy, University of Sydney, Sydney, NSW, Australia. james.gillespie@sydney.edu.au.|Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia. james.gillespie@sydney.edu.au.
authors.forename: James
authors.initials: J
authors.lastname: Gillespie
authors.affiliation: eHealthNSW, NSW Health, Sydney, Australia. steve.boyages@gmail.com.
authors.forename: Steven
authors.initials: S
authors.lastname: Boyages
authors.affiliation: The George Institute for Global Health, Camperdown, NSW, Australia. sjan@thegeorgeinstitute.org.
authors.forename: Stephen
authors.initials: S
authors.lastname: Jan
authors.affiliation: Menzies Centre for Health Policy, University of Sydney, Sydney, NSW, Australia. stephen.leeder@sydney.edu.au.
authors.forename: Stephen
authors.initials: S
authors.lastname: Leeder
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001315:Australia / Q000453:epidemiology; D002908:Chronic Disease; D003710:Demography; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D005544:Forecasting; D006760:Hospitalization / Q000639:trends*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012043:Regression, Psychology; D012307:Risk Factors; D055815:Young Adult