The Library
Longitudinal patterns of emergency department use by older frequent emergency department users : a state sequence analysis approach to understand health care service use over time
Tools
Muriithi, Betsy Njeri (2021) Longitudinal patterns of emergency department use by older frequent emergency department users : a state sequence analysis approach to understand health care service use over time. PhD thesis, University of Warwick.
|
PDF
WRAP_Theses_Muriithi_2021.pdf - Submitted Version - Requires a PDF viewer. Download (3261Kb) | Preview |
Official URL: http://webcat.warwick.ac.uk/record=b3685614~S15
Abstract
Background: Older emergency department users identified as frequent emergency department users represent a vulnerable population whose emergency department use may indicate issues in the organisation of care resulting in persistently unmet needs that culminate in a health emergency. Health service interventions designed to improve health and service outcomes have shown mixed evidence of effectiveness. Extant literature suggests that varying patterns of use complicate the implementation of targeted interventions that address their health care needs.
Aim: To explore the varying patterns of longitudinal emergency department use by older frequent emergency department users; characterise subgroups classified by their longitudinal patterns of use; and examine the determinants of the patterns of use with a view of highlighting where targeted interventions could be placed to improve their efficiency.
Methods: The research applied State Sequence Analysis and Agglomerative Hierarchical Clustering to a sample of older frequent emergency department users. The analysis built six-year care trajectories from a regional extract of the Hospital Episode Statistics. The study used multinomial logistic regression to examine the determinants, available in the Hospital Episodes Statistics dataset, of the patterns of use.
Results: The research identified four patterns of use consistently after varying dissimilarity/distance measures and associated parameters. Of the 13,131 older frequent emergency department users, 65% had short-term frequent use, 30% had long-term regular use, 4.6% had long-term frequent use, and only 0.5% had long-term super use. Long-term super users had the highest rates of non-urgent presentations, unique providers visited, and 7-day and 30-day emergency department re-visits. Short-term frequent users were more likely to be much older, male, and living in less deprived rural areas.
Conclusion: The results demonstrate the efficacy of the proposed methodology framework for modelling longitudinal health care service utilisation patterns. The significant differences in the characteristics between subgroups by the patterns of use demonstrate varying needs that would require tailored service interventions.
Item Type: | Thesis (PhD) | ||||
---|---|---|---|---|---|
Subjects: | R Medicine > RA Public aspects of medicine R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine |
||||
Library of Congress Subject Headings (LCSH): | Emergency medical services -- Great Britain, Hospitals -- Emergency services -- Great Britain, Older people -- Medical care -- Great Britain | ||||
Official Date: | March 2021 | ||||
Dates: |
|
||||
Institution: | University of Warwick | ||||
Theses Department: | Warwick Business School | ||||
Thesis Type: | PhD | ||||
Publication Status: | Unpublished | ||||
Supervisor(s)/Advisor: | White, Leroy ; Burgess, Nicola | ||||
Sponsors: | Shrewsbury and Telford Hospital NHS Trust | ||||
Format of File: | |||||
Extent: | xvii, 244 leaves : colour illustrations | ||||
Language: | eng |
Request changes or add full text files to a record
Repository staff actions (login required)
View Item |