title: Understanding the distribution of A&E attendances and hospital admissions for the case managed population: A single case cross sectional study.
abstract: To describe the characteristics of case-managed patients presenting at accident and emergency (A & E) and to explore the distribution of their attendances and admissions.
  
  
  
  Recently, the UK Government announced extended-hours primary care provision in an effort to reduce the growing utilization of A & E. No evidence is available to understand the use of acute services by this high-risk patient group.
  
  
  
  A cross-sectional design utilising routinely collected anonymsed A & E attendance and hospital admission data from 2010 to 2015.
  
  
  
  The case-managed population is typically 70years and older and most often arrive at A & E via emergency services and during the night (00:00-08:59). A large proportion are subsequently admitted having a statistically significant A & E conversion rate. No variables were predictive of admission.
  
  
  
  The high level of A&E conversion could indicate case-managed patients are presenting appropriately with acute clinical need. However, inadequate provision in primary-care could drive decisions for admitting vulnerable patients.
authors.affiliation: Birmingham City University, Faculty of Health, Education and Life Sciences, City South Campus, Westbourne Road, Edgbaston, Birmingham, B15 3TN, United Kingdom. Electronic address: http://@EEP_PhDANP.
authors.forename: Eloise
authors.initials: E
authors.lastname: Phillips
authors.affiliation: Birmingham City University, Faculty of Health, Education and Life Sciences, City South Campus, Westbourne Road, Edgbaston, Birmingham, B15 3TN, United Kingdom. Electronic address: sarahjane.jones@bcu.ac.uk.
authors.forename: Sarahjane
authors.initials: S
authors.lastname: Jones
authors.affiliation: Birmingham City University, Faculty of Health, Education and Life Sciences, City South Campus, Westbourne Road, Edgbaston, Birmingham, B15 3TN, United Kingdom. Electronic address: jessica.runacres@bcu.ac.uk.
authors.forename: Jessica
authors.initials: J
authors.lastname: Runacres
authors.affiliation: Birmingham City University, Faculty of Business, Law and Social Sciences, City Centre Campus, Curzon Building, 4 Cardigan Street, Birmingham, B4 7BD, United Kingdom. Electronic address: maxine.lintern@bcu.ac.uk.
authors.forename: Maxine
authors.initials: M
authors.lastname: Lintern
authors.affiliation: University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry, CV2 2DX, United Kingdom. Electronic address: http://@uhcw_nursing.
authors.forename: Mark
authors.initials: M
authors.lastname: Radford
mesh_terms: D000368:Aged; D019090:Case Management; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D010343:Patient Admission / Q000706:statistics & numerical data*; D013222:State Medicine; D006113:United Kingdom
keywords: After-hours care; Case management; Chronic disease management; Data accuracy; Long-term conditions