Monday, June 6, 2016

Top reasons for emergency visits - can early detection help to lower the numbers?

Top reasons for emergency visits & hospitalization

In the United States, the Emergency Department (ED) sees around 136.6 million patients per year. Just over 50% of that number falls between the ages of 25-64, and within this age group, 40-55% of patients enter the ED with high blood pressure (>140/90). This high percentage is instrumental to the fact that so many of the conditions seen upon admittance to the ED are chronic diseases, as high blood pressure is a factor for many including heart disease, respiratory disease and diabetes.

The top five reasons for admission to the Emergency Department differs between age groups:

18-44 years
45-64 years
65-84 years
Mood disorders
Diabetes mellitus
Chest pain
Heart failure
Skin infection
Psychotic disorder
Gallbladder disease
Skin infection
Cardiac dysrhythmias

As age increases, the number of hospital visits increase significantly and these visits tend to be for chronic conditions. In fact, among the top 10 discharge diagnoses in the upper age groups, half could be detected early. These include heart disease, chest pain, cerebrovascular disease, ischemic heart disease and diabetes mellitus. Early diagnosis of these conditions can make them more manageable and sometimes even reversible.

Cost factor of these visits

On average, the annual aggregate cost of all hospital stays in the US is $375.9 billion. Adults between 45-84 account for nearly two-thirds of this, and each visit in that age group averages at $12,200. The costliest conditions involve those associated with the circulatory system including acute myocardial infarction, coronary atherosclerosis, congestive heart failure cerebrovascular disease and cardiac arrhythmias.

The problem with circulatory disease is that it often exists alongside metabolic conditions including diabetes, respiratory disease and obesity. These chronic conditions are becoming an undeniable global burden on the healthcare system and therefore have become a primary focus for public health policy, early detection methods and lifestyle intervention.

Can early detection lower this number?

The aim of early detection is to diagnose people with chronic diseases before they experience any symptoms. In most cases of disease, the earlier it is detected, the better the prognosis is. As the presence of chronic conditions at the ED account for over 15% of all visits, many public health screening programs exist to identify people with these conditions. However, these screening programs can be expensive and oftentimes may not be feasible to run.

If both healthcare professional and patient are made aware of a potential risk or likelihood of disease developing, more can be done to monitor and avoid a severe medical event. If a patient is identified as high risk, lifestyle behaviors can be modified and regular screening can be prescribed.

Innovative mobile technology is now demonstrating that it can in fact be used for both early detection and ongoing monitoring of chronic disease. Mobile apps are able to assist in detecting disease through complex algorithms which combine health information, medical history and lifestyle factors to produce a risk level. If higher risk individuals are alerted early enough, evidence shows that the number of hospitalizations, and therefore overall cost of medical care, can significantly decrease.

Lee S (2004). Early detection of disease and scheduling of screening examinations. Statistical Methods in Medical Research.

Charles M et al (2012). Impact of early detection and treatment of diabetes on the 6-year prevalence of cardiac autonomic neuropathy in people with screen-detected diabetes: ADDITION-Denmark, a cluster-randomised study. Diabetoogia

Soriano JB (2010). Screening for and early detection of chronic obstructive pulmonary disorder. The Lancet.