title: Measuring care trajectories using health administrative databases: a population-based investigation of transitions from emergency to acute care.
abstract: A patient's trajectory through the healthcare system affects resource use and outcomes. Data fields in population-based administrative health databases are potentially valuable resources for constructing care trajectories for entire populations, provided they can capture patient transitions between healthcare services. This study describes patient transitions from the emergency department (ED) to other healthcare settings, and ascertains whether the discharge disposition field recorded in the ED data was a reliable source of patient transition information from the emergency to the acute care settings.
  
  
  
  Administrative health databases from the province of Saskatchewan, Canada (population 1.1 million) were used to identify patients with at least one ED visit to provincial teaching hospitals (n = 5) between April 1, 2006 and March 31, 2012. Discharge disposition from ED was described using frequencies and percentages; and it includes categories such as home, transfer to other facilities, and died. The kappa statistic with 95 % confidence intervals (95 % CIs) was used to measure agreement between the discharge disposition field in the ED data and hospital admission records.
  
  
  
  We identified N = 1,062,861 visits for 371,480 patients to EDs over the six-year study period. Three-quarters of the discharges were to home, 16.1 % were to acute care in the same facility in which the ED was located, and 1.6 % resulted in a patient transfer to a different acute care facility. Agreement between the discharge disposition field in the ED data and hospital admission records was good when the emergency and acute care departments were in the same facility (κ = 0.77, 95 % CI 0.77, 0.77). For transfers to a different acute care facility, agreement was only fair (κ = 0.36, 95 % CI 0.35, 0.36).
  
  
  
  The majority of patients who attended EDs did not transition to another healthcare setting. For those who transitioned to acute care, accuracy of the discharge disposition field depended on whether the two services were provided in the same facility. Using the hospital data as reference, we conclude that the discharge disposition field in the ED data is not reliable for measuring transitions from ED to acute care.
authors.affiliation: Department of Community Health Sciences, College of Medicine, Faculty of Health Sciences, University of Manitoba, 750 Bannatyne Avenue, Winnipeg, MB, R3E 0 W3, Canada. kuwornuj@myumanitoba.ca.
authors.forename: John Paul
authors.initials: JP
authors.lastname: Kuwornu
authors.affiliation: Department of Community Health Sciences, College of Medicine, Faculty of Health Sciences, University of Manitoba, 750 Bannatyne Avenue, Winnipeg, MB, R3E 0 W3, Canada.|Saskatchewan Health Quality Council, 111 Research Drive, Saskatoon, SK, S7N 3R2, Canada.
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Lix
authors.affiliation: Department of Community Health Sciences, College of Medicine, Faculty of Health Sciences, University of Manitoba, 750 Bannatyne Avenue, Winnipeg, MB, R3E 0 W3, Canada.|Saskatchewan Health Quality Council, 111 Research Drive, Saskatoon, SK, S7N 3R2, Canada.
authors.forename: Jacqueline M
authors.initials: JM
authors.lastname: Quail
authors.affiliation: Saskatchewan Health Quality Council, 111 Research Drive, Saskatoon, SK, S7N 3R2, Canada.
authors.forename: Xiaoyun Eric
authors.initials: XE
authors.lastname: Wang
authors.affiliation: Saskatchewan Health Quality Council, 111 Research Drive, Saskatoon, SK, S7N 3R2, Canada.
authors.forename: Meric
authors.initials: M
authors.lastname: Osman
authors.affiliation: Department of Community Health Sciences, College of Medicine, Faculty of Health Sciences, University of Manitoba, 750 Bannatyne Avenue, Winnipeg, MB, R3E 0 W3, Canada.|Saskatchewan Health Quality Council, 111 Research Drive, Saskatoon, SK, S7N 3R2, Canada.
authors.forename: Gary F
authors.initials: GF
authors.lastname: Teare
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D016208:Databases, Factual; D004632:Emergency Medical Services / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital; D005260:Female; D006753:Hospital Records; D006760:Hospitalization; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D010360:Patient Transfer / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012525:Saskatchewan
keywords: Agreement; Data linkage; Emergency department; Healthcare trajectory; Hospital records