Frequent use of hospital inpatient services during a nine year period: a retrospective cohort study

Adelle M Springer,Shu Q Li,John R Condon,Steven L Guthridge

doi:10.1186/s12913-017-2285-1

Abstract

BackgroundFrequent use (FU) of hospital services impacts on patients and health service expenditure. Studies examining FU in emergency departments and inpatient settings have found heterogeneity and the need to differentiate between potentially preventable FU and that associated with ongoing management of complex conditions. Psychosocial factors have often been reported as underpinning or exacerbating the phenomena.Most FU studies have been limited by time, to a single study site, or restricted to specific diagnoses or patient groups. This study provides a comprehensive description of adult patient characteristics, conditions and risk factors associated with FU, based on admissions to the five public hospitals in the Northern Territory (NT) of Australia over a nine year period. The study population is distinctive comprising both Aboriginal and non-Aboriginal patients.MethodsData on all inpatient episodes in NT public hospitals between 2005 and 2013 was analysed to identify patients with any FU (four or more episodes within any 12-month period) and measure FU duration (number of FU years) and intensity (mean number of episodes per FU year). Pregnancy, alcohol-related and mental health condition flags were assigned to patients with any episode with relevant diagnoses during the study period. Multivariate analysis was used to assess factors associated with any FU, FU duration and FU intensity, separately for Aboriginal and non-Aboriginal patients.ResultsOf people with any inpatient episodes during the study period, 13.6% were frequent users (Aboriginal 22%, non-Aboriginal 10%) accounting for 46.6% of all episodes. 73% of frequent users had only one FU year. Any FU and increased FU duration were more common among individuals who were: Aboriginal; older; female; and those with a pregnancy, alcohol or mental health flag. Having two or more alcohol-related episodes in the nine-year period was strongly associated with any FU for both Aboriginal (odds ratio 8.9, 95% CI. 8.20–9.66) and non-Aboriginal patients (11.5, 9.92–13.26).ConclusionFor many people, frequent inpatient treatment is necessary and unavoidable. This study suggests that damage arising from excessive alcohol consumption (either personal or by others) is the single most avoidable factor associated with FU, particularly for Aboriginal people.

Highlights

Frequent use (FU) of hospital services impacts on patients and health service expenditure
Most frequent users had a single FU year, increased FU duration was higher for Aboriginal patients; crude odds ratio of 2.02
The strongest risk factor identified in this study is a history of damage attributable directly or indirectly to excessive alcohol consumption, for Aboriginal people

Summary

Introduction

Frequent use (FU) of hospital services impacts on patients and health service expenditure. This study provides a comprehensive description of adult patient characteristics, conditions and risk factors associated with FU, based on admissions to the five public hospitals in the Northern Territory (NT) of Australia over a nine year period. This study examined patient characteristics and factors associated with FU of hospital inpatient services including alcohol and mental health in the NT, a large and remote jurisdiction in northern and central Australia where Aboriginal people comprise 30% of the population (compared with 3% nationally) [16]. The Aboriginal Australian population (Aboriginal and Torres Strait Islander peoples) has much worse social, economic and environmental conditions, and a much greater burden of chronic disease, associated risk factors and comorbidities than Australians generally, including pervasive end-stage kidney disease, and greater use of acute care services [17,18,19]. Excessive alcohol consumption is much more common among Aboriginal than other Australians; one study estimated that in the period from 1998–99 to 2008–09 the annual alcohol-attributable hospitalisation rate for the NT Aboriginal population was 329.2 per 10,000, which was nearly seven times the corresponding rate for the nonAboriginal population (49.6 per 10,000) [20]

Methods

Results

Discussion

Conclusion