title: Pre-emergency-department care-seeking patterns are associated with the severity of presenting condition for emergency department visit and subsequent adverse events: a timeframe episode analysis.
abstract: BACKGROUND
  Many patients treated in Emergency Department (ED) visits can be treated at primary or urgent care sectors, despite the fact that a number of ED visitors seek other forms of care prior to an ED visit. However, little is known regarding how the pre-ED activity episodes affect ED visits.
  
  
  OBJECTIVE
  We investigated whether care-seeking patterns involve the use of health care services of various types prior to ED visits and examined the associations of these patterns with the severity of the presenting condition for the ED visit (EDVS) and subsequent events.
  
  
  METHODS
  This retrospective observational study used administrative data on beneficiaries of the universal health care insurance program in Taiwan. The service type, treatment capacity, and relative diagnosis were used to classify pre-ED visits into 8 care types. Frequent pattern analysis was used to identify sequential care-seeking patterns and to classify 667,183 eligible pre-ED episodes into patterns. Generalized linear models were developed using generalized estimating equations to examine the associations of these patterns with EDVS and subsequent events.
  
  
  RESULTS
  The results revealed 17 care-seeking patterns. The EDVS and likelihood of subsequent events significantly differed among patterns. The ED severity index of patterns differ from patterns seeking directly ED care (coefficients ranged from -0.05 to 0.13), and the odds-ratios for the likelihood of subsequent ED visits and hospitalization ranged from 1.18 to 1.86 and 1.16 to 2.84, respectively.
  
  
  CONCLUSIONS
  The pre-ED care-seeking patterns differ in severity of presenting condition and subsequent events that may represent different causes of ED visit. Future health policy maker may adopt different intervention strategies for targeted population to reduce unnecessary ED visit effectively.
authors.affiliation: Department of Information Management and Innovation Center for Big Data and Digital Convergence, Yuan Ze University, Chung-Li, Taiwan.
authors.forename: Chien-Lung
authors.initials: CL
authors.lastname: Chan
authors.affiliation: Department of Health Care Administration, Chang Jung Christian University, Tainan, Taiwan.
authors.forename: Wender
authors.initials: W
authors.lastname: Lin
authors.affiliation: Community Health Research Center & Institute of Public Health, National Yang-Ming University, Taipei, Taiwan; Keelung Hospital, Ministry of Health and Welfare, Keelung, Taiwan.
authors.forename: Nan-Ping
authors.initials: NP
authors.lastname: Yang
authors.affiliation: Department of Computer Science and Engineering, and Innovation Center for Big Data and Digital Convergence, Yuan Ze University, Chung-Li, Taiwan.
authors.forename: K Robert
authors.initials: KR
authors.lastname: Lai
authors.affiliation: Department of Information Management and Innovation Center for Big Data and Digital Convergence, Yuan Ze University, Chung-Li, Taiwan; Medical Affairs Division, National Health Insurance Administration, Ministry of Health and Welfare, Taipei, Taiwan.
authors.forename: Hsin-Tsung
authors.initials: HT
authors.lastname: Huang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D019468:Disease Management; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D055815:Young Adult