JMIR Publications

ABSTRACT

Background:

Unscheduled return visits to the ED (EDRVs) are a key indicator for monitoring the quality of emergency medical care. A high return rate implies that the medical services provided by the ED failed to achieve the expected results of accurate diagnosis and effective treatment. Older adults also utilize more emergency medical resources than people in other age demographics do. Many studies have reviewed the causes of EDRVs among general ED patients, yet few have focused on older adults, even though this is the age group with the highest rate of EDRVs.

Objective:

Older adults are more susceptible to diseases and comorbidities than younger adults are, and they exhibit unique and complex clinical characteristics that increase the difficulty of clinical diagnosis and treatment. This study establishes a model for predicting unscheduled emergency department return visits (EDRVs) within a 72-hour period among adult patients 65 years and older. In addition, we investigate the effects of the influencing factors on their unscheduled EDRVs.

Methods:

We used stratified and randomized data from Taiwan’s National Health Insurance Research Database (NHIRD) and employed data mining techniques to construct a prediction model consisting of patient, disease, hospital, and physician characteristics. Records of visits to an ED by patients 65 years and older from 1996 to 2010 in NHIRD were selected and the final sample size was 49,252 records.

Results:

The decision tree of the prediction model achieved an acceptable overall accuracy of 76.80%. Economic status, chronic illness, and length of stay (LOS) in the emergency department (ED) were the top three variables influencing unscheduled EDRVs. Those who stayed in the ED overnight or longer on their first visit were less likely to return. This study confirms the results of prior studies that found economically underprivileged older adults with chronic illness and comorbidities to be more likely to return to the ED.

Conclusions:

The developed predication model could serve as a valuable reference for future government planning and promotion of medical services and age-friendly policies. Most emergency medicine curricula do not include geriatrics, although this is beginning to change in some countries. Until geriatric emergency medicine becomes an established practice, a longer LOS in the ED may serve as a temporary solution to reduce the growing number of unscheduled EDRVs by older patients.