Foster, Margaret

Giannouchos, Theodoros

Kum, Hye-Chung

Ohsfeldt, Robert

English

Texas A&M University

 PROSPERO
International prospective register of systematic reviews
 Characteristics and predictors of adult frequent emergency departments users in the
United States: a systematic literature review
 Theodoros Giannouchos, Hye-Chung Kum, Margaret Foster, Robert Ohsfeldt
 
Citation
 
Theodoros Giannouchos, Hye-Chung Kum, Margaret Foster, Robert Ohsfeldt. Characteristics and
predictors of adult frequent emergency departments users in the United States: a systematic
literature review. PROSPERO 2018 CRD42018105014 Available from: 
http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42018105014
 
Review question
The objective of this review is to identify the characteristics and the factors associated with adult frequent
emergency department (FED) users in the United States, how these serve as predictors of frequent use and
how these are unique to this specific group of ED users compared non-FED users.
 
Searches
The search was conducted in three major biomedical electronic databases (MEDLINE, CINAHL, EMBASE)
from May 2018 to July 2018. Limits included only English language studies and studies published after 2010.
The terms "emergency department" and "frequent visits" were the 2 main search concepts used with the
collaboration of an information specialist (MF).
MEDLINE search strategy: 1. (emergency adj1 (ward or department)).ti, ab.) or exp Emergency Service, Hospital/ 
2. (((heavy or frequen*) adj2 (use* or visit*)) or recidivis*).ti, ab. 
3. 1 and 2
4. limit 3 to yr="2010 -Current"
5. limit 4 to english language 
6. (animals not humans).sh.
7. 5 not 6
 
Types of study to be included
Studies using primary or secondary data will be included, as long as they provide information on FED users.
Purely qualitative/exploratory studies will be excluded.
 
Condition or domain being studied
Frequent Emergency Department (FED) users are small subgroup of all emergency departments (ED) users
but are responsible for a disproportionate number of ED visits (Hunt et al, 2006). Unnecessary ED utilization
has been linked to increasing ED costs and ED crowding, with important negative outcomes for patients
(Hoot et al, 2008). Although it is assumed that FED users uninsured and old people, who lack access to
primary care services and use the ED for non-urgent reasons ( Blank et al, 2005, Fuda et al, 2006), the
majority of the current literature has identified commonalities among FED users related to public insurance,
multiple chronic conditions, mental health and substance abuse disorders (LaCalle et, 2010, Soril et al,
2016). We attempt to explore the characteristics and contextual factors that are more prevalent among FED
users compared to non-FED users.
 
Participants/population
US Studies after 2010, including adults or at least all ages and in English language are going to be included.
Studies focused on specific ED users subgroups (eg only Medicaid patients, ED users for a specific
condition), children and purely qualitative studies are going to be excluded.
 
Intervention(s), exposure(s)
                               Page: 1 / 4
 PROSPERO
International prospective register of systematic reviews
All studies that provide descriptive information about FED users and use any methodology that compared
FED users with non-FED users will be taken into account.
 
Comparator(s)/control
Control patients are going to be infrequent ED users.
 
Context
 
Primary outcome(s)
The presentation of the characteristics and factors that describe who the FED users are, how these
differentiate them form infrequent users and how these serve as predictors of FED use.
 
Secondary outcome(s)
None.
 
Data extraction (selection and coding)
A three step process will be used to identify the studies that are going to be included in this review; by title,
by abstract and by full-text. Two researchers will separately be involved in this procedure. Conversation and
consensus for resolving any potential diverging opinions will be facilitated. Data will be extracted using a
survey, which will be pre- and pilot tested for its validity with studies that fit all the inclusion criteria except for
the year of publication (e.g. studies prior to 2010). We will extract demographic information (e.g. age, race,
gender, socioeconomic status, education, employment status), clinical information (e.g. specific clinical
conditions, abuse disorders, tobacco use, number of chronic conditions), and information regarding access
and use of the healthcare system (e.g .usual source of care, hospitalization, admission rates, number or
provider and ED visits).
 
Risk of bias (quality) assessment
Studies will be evaluated using the Joanna Briggs Institute Appraisal Checklist tool (Moola et al, 2017), which
will be slightly modified to fit the scope of this study.
Two reviewers will independently assess the quality of the studies and Gwet's AC1 statistic will be calculated
to present inter-rater reliability. Risk of bias will be summarized for specific outcomes within a study
and specific outcomes across studies.
 
Strategy for data synthesis
Results will be presented as aggregates of the number of studies that these were found in. Percentages of
single or bivariate outcomes related to FED use and adjusted margins. Odds Ratios in multivariable models
will be synthesized by presenting the lowest and highest results found in all of the studies. This review will try
to present such results and will not combine the studies' findings using quantitative methodology.
 
Analysis of subgroups or subsets
FED users will be compared with non-FED users to identify potential differences among these two groups.
 
Contact details for further information
Theodoros Giannouchos
tgiannouchos@gmail.com
 
Organisational affiliation of the review
Texas A&M University, School of Public Health, Dept. of Health Policy and Management
https://sph.tamhsc.edu/
 
Review team members and their organisational affiliations
Mr Theodoros Giannouchos. Texas A&M University, School of Public Health, Dept. of Health Policy and
Management
Dr Hye-Chung Kum. Texas A&M University, School of Public Health, Dept. of Health Policy and
Management
                               Page: 2 / 4
 PROSPERO
International prospective register of systematic reviews
Mr Margaret Foster. Texas A&M University, Medical Sciences Library
Dr Robert Ohsfeldt. Texas A&M University, School of Public Health, Dept. of Health Policy and Management
 
Anticipated or actual start date
18 May 2018
 
Anticipated completion date
31 August 2018
 
Funding sources/sponsors
None
 
Conflicts of interest
 
Language
English
 
Country
United States of America
 
Stage of review
Review_Completed_not_published
 
Subject index terms status
Subject indexing assigned by CRD
 
Subject index terms
Adult; Emergency Service, Hospital; Humans; Publications; United States
 
Date of registration in PROSPERO
13 August 2018
 
Date of publication of this version
26 September 2018
 
Details of any existing review of the same topic by the same authors
 
Stage of review at time of this submission
 
Stage Started Completed
Preliminary searches Yes Yes
Piloting of the study selection process Yes Yes
Formal screening of search results against eligibility criteria Yes Yes
Data extraction Yes Yes
Risk of bias (quality) assessment Yes Yes
Data analysis Yes Yes
 
Versions
 
13 August 2018
26 September 2018
                               Page: 3 / 4
 PROSPERO
International prospective register of systematic reviews
PROSPERO
This information has been provided by the named contact for this review. CRD has accepted this information in good
faith and registered the review in PROSPERO. CRD bears no responsibility or liability for the content of this registration
record, any associated files or external websites. 
Powered by TCPDF (www.tcpdf.org)
                               Page: 4 / 4


Characteristics and predictors of adult frequent emergency departments users in the United States: a systematic literature review

Texas A&amp;M Repository

 PROSPEROInternational prospective register of systematic reviews Characteristics and predictors of adult frequent emergency departments users in theUnited States: a systematic literature review Theodoros Giannouchos, Hye-Chung Kum, Margaret Foster, Robert Ohsfeldt Citation Theodoros Giannouchos, Hye-Chung Kum, Margaret Foster, Robert Ohsfeldt. Characteristics andpredictors of adult frequent emergency departments users in the United States: a systematicliterature review. PROSPERO 2018 CRD42018105014 Available from: http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42018105014 Review questionThe objective of this review is to identify the characteristics and the factors associated with adult frequentemergency department (FED) users in the United States, how these serve as predictors of frequent use andhow these are unique to this specific group of ED users compared non-FED users. SearchesThe search was conducted in three major biomedical electronic databases (MEDLINE, CINAHL, EMBASE)from May 2018 to July 2018. Limits included only English language studies and studies published after 2010.The terms "emergency department" and "frequent visits" were the 2 main search concepts used with thecollaboration of an information specialist (MF).MEDLINE search strategy: 1. (emergency adj1 (ward or department)).ti, ab.) or exp Emergency Service, Hospital/ 2. (((heavy or frequen*) adj2 (use* or visit*)) or recidivis*).ti, ab. 3. 1 and 24. limit 3 to yr="2010 -Current"5. limit 4 to english language 6. (animals not humans).sh.7. 5 not 6 Types of study to be includedStudies using primary or secondary data will be included, as long as they provide information on FED users.Purely qualitative/exploratory studies will be excluded. Condition or domain being studiedFrequent Emergency Department (FED) users are small subgroup of all emergency departments (ED) usersbut are responsible for a disproportionate number of ED visits (Hunt et al, 2006). Unnecessary ED utilizationhas been linked to increasing ED costs and ED crowding, with important negative outcomes for patients(Hoot et al, 2008). Although it is assumed that FED users uninsured and old people, who lack access toprimary care services and use the ED for non-urgent reasons ( Blank et al, 2005, Fuda et al, 2006), themajority of the current literature has identified commonalities among FED users related to public insurance,multiple chronic conditions, mental health and substance abuse disorders (LaCalle et, 2010, Soril et al,2016). We attempt to explore the characteristics and contextual factors that are more prevalent among FEDusers compared to non-FED users. Participants/populationUS Studies after 2010, including adults or at least all ages and in English language are going to be included.Studies focused on specific ED users subgroups (eg only Medicaid patients, ED users for a specificcondition), children and purely qualitative studies are going to be excluded. Intervention(s), exposure(s)                               Page: 1 / 4 PROSPEROInternational prospective register of systematic reviewsAll studies that provide descriptive information about FED users and use any methodology that comparedFED users with non-FED users will be taken into account. Comparator(s)/controlControl patients are going to be infrequent ED users. Context Primary outcome(s)The presentation of the characteristics and factors that describe who the FED users are, how thesedifferentiate them form infrequent users and how these serve as predictors of FED use. Secondary outcome(s)None. Data extraction (selection and coding)A three step process will be used to identify the studies that are going to be included in this review; by title,by abstract and by full-text. Two researchers will separately be involved in this procedure. Conversation andconsensus for resolving any potential diverging opinions will be facilitated. Data will be extracted using asurvey, which will be pre- and pilot tested for its validity with studies that fit all the inclusion criteria except forthe year of publication (e.g. studies prior to 2010). We will extract demographic information (e.g. age, race,gender, socioeconomic status, education, employment status), clinical information (e.g. specific clinicalconditions, abuse disorders, tobacco use, number of chronic conditions), and information regarding accessand use of the healthcare system (e.g .usual source of care, hospitalization, admission rates, number orprovider and ED visits). Risk of bias (quality) assessmentStudies will be evaluated using the Joanna Briggs Institute Appraisal Checklist tool (Moola et al, 2017), whichwill be slightly modified to fit the scope of this study.Two reviewers will independently assess the quality of the studies and Gwet's AC1 statistic will be calculatedto present inter-rater reliability. Risk of bias will be summarized for specific outcomes within a studyand specific outcomes across studies. Strategy for data synthesisResults will be presented as aggregates of the number of studies that these were found in. Percentages ofsingle or bivariate outcomes related to FED use and adjusted margins. Odds Ratios in multivariable modelswill be synthesized by presenting the lowest and highest results found in all of the studies. This review will tryto present such results and will not combine the studies' findings using quantitative methodology. Analysis of subgroups or subsetsFED users will be compared with non-FED users to identify potential differences among these two groups. Contact details for further informationTheodoros Giannouchostgiannouchos@gmail.com Organisational affiliation of the reviewTexas A&M University, School of Public Health, Dept. of Health Policy and Managementhttps://sph.tamhsc.edu/ Review team members and their organisational affiliationsMr Theodoros Giannouchos. Texas A&M University, School of Public Health, Dept. of Health Policy andManagementDr Hye-Chung Kum. Texas A&M University, School of Public Health, Dept. of Health Policy andManagement                               Page: 2 / 4 PROSPEROInternational prospective register of systematic reviewsMr Margaret Foster. Texas A&M University, Medical Sciences LibraryDr Robert Ohsfeldt. Texas A&M University, School of Public Health, Dept. of Health Policy and Management Anticipated or actual start date18 May 2018 Anticipated completion date31 August 2018 Funding sources/sponsorsNone Conflicts of interest LanguageEnglish CountryUnited States of America Stage of reviewReview_Completed_not_published Subject index terms statusSubject indexing assigned by CRD Subject index termsAdult; Emergency Service, Hospital; Humans; Publications; United States Date of registration in PROSPERO13 August 2018 Date of publication of this version26 September 2018 Details of any existing review of the same topic by the same authors Stage of review at time of this submission Stage Started CompletedPreliminary searches Yes YesPiloting of the study selection process Yes YesFormal screening of search results against eligibility criteria Yes YesData extraction Yes YesRisk of bias (quality) assessment Yes YesData analysis Yes Yes Versions 13 August 201826 September 2018                               Page: 3 / 4 PROSPEROInternational prospective register of systematic reviewsPROSPEROThis information has been provided by the named contact for this review. CRD has accepted this information in goodfaith and registered the review in PROSPERO. CRD bears no responsibility or liability for the content of this registrationrecord, any associated files or external websites. Powered by TCPDF (www.tcpdf.org)                               Page: 4 / 4

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Characteristics and predictors of adult frequent emergency departments users in the United States: a systematic literature review

Abstract

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Texas A&M University

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Characteristics and predictors of adult frequent emergency departments users in the United States: a systematic literature review

Abstract

Similar works

Full text

Available Versions

Texas A&M University

Texas A&amp;M Repository

Texas A&M Repository