title: Identifying Frequent Users of an Urban Emergency Medical Service Using Descriptive Statistics and Regression Analyses.
abstract: This retrospective cohort study provides a descriptive analysis of a population that frequently uses an urban emergency medical service (EMS) and identifies factors that contribute to use among all frequent users. For purposes of this study we divided frequent users into the following groups: low- frequent users (4 EMS transports in 2012), medium-frequent users (5 to 6 EMS transports in 2012), high-frequent users (7 to 10 EMS transports in 2012) and super-frequent users (11 or more EMS transports in 2012). Overall, we identified 539 individuals as frequent users. For all groups of EMS frequent users (i.e. low, medium, high and super) one or more hospital admissions, receiving a referral for follow-up care upon discharge, and having no insurance were found to be statistically significant with frequent EMS use (P<0.05). Within the diagnostic categories, 41.61% of super-frequent users had a diagnosis of "primarily substance abuse/misuse" and among low-frequent users a majority, 53.33%, were identified as having a "reoccurring (medical) diagnosis." Lastly, relative risk ratios for the highest group of users, super-frequent users, were 3.34 (95% CI [1.90-5.87]) for obtaining at least one referral for follow-up care, 13.67 (95% CI [5.60-33.34]) for having four or more hospital admissions and 5.95 (95% CI [1.80-19.63]) for having a diagnoses of primarily substance abuse/misuse. Findings from this study demonstrate that among low- and medium-frequent users a majority of patients are using EMS for reoccurring medical conditions. This could potentially be avoided with better care management. In addition, this study adds to the current literature that illustrates a strong correlation between substance abuse/misuse and high/super-frequent EMS use. For the subgroup analysis among individuals 65 years of age and older, we did not find any of the independent variables included in our model to be statistically significant with frequent EMS use.
authors.affiliation: Brown University, School of Public Health, Providence, Rhode Island.
authors.forename: Chenelle
authors.initials: C
authors.lastname: Norman
authors.affiliation: Brown University, Department of Emergency Medicine, Providence, Rhode Island; Rhode Island Hospital, Injury Prevention Center, Providence, Rhode Island; Brown University, School of Public Health, Providence, Rhode Island.
authors.forename: Michael
authors.initials: M
authors.lastname: Mello
authors.affiliation: Brown University, Department of Emergency Medicine, Providence, Rhode Island; Brown University, School of Public Health, Providence, Rhode Island.
authors.forename: Bryan
authors.initials: B
authors.lastname: Choi
mesh_terms: D017677:Age Distribution; D002908:Chronic Disease / Q000453:epidemiology*; D057286:Electronic Health Records / Q000706:statistics & numerical data*; D004632:Emergency Medical Services / Q000706:statistics & numerical data; D006300:Health Services Misuse / Q000706:statistics & numerical data*; D006801:Humans; D012044:Regression Analysis; D012189:Retrospective Studies; D012237:Rhode Island / Q000453:epidemiology; D017678:Sex Distribution; D019966:Substance-Related Disorders / Q000453:epidemiology*; D014505:Urban Population
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