Emergency CareFECNCT05953467
Healthcare Seeking Behavior of Frequent Emergency Care Visitors
An observational study of Emergency Care and Acute Care Chain, run by Zuyderland Medisch Centrum at 1 site in Netherlands.
Trial summary
This retrospective study is part of a research line from Zuyderland Medical Centre focusing on the acute care chain. The aim of the study is to focus on the frequent visitors of the Emergency Department (ED) and bridge the gap to out-of-hours primary care. Read more about this study
- Who is it for?
- Ages 18 years and olderHealthy volunteers can take part
- Conditions the study is for
- Emergency Care, Acute Care Chain
- How many people
- 700 participants
- Where
- 1 siteNetherlands
- Study dates
- 11 Jul 2023to 31 Dec 2024
- Phase
- Observational
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 years and older
- All sexes
- Healthy volunteers accepted
- Adult, Older adult
Study population: All patients presenting at the ED or GPC of Zuyderland Medical Center between 1 January 2022 and 31 December 2022, with an age of 18 years or older at time of first presentation during the inclusion period, will be included. Frequent visitors, defined as patients visiting the ED or GPC 4 times or more during these 12 months, will be identified and characterized. The geography of south east Limburg and the locations of EDs with integrated GPC, ensure that visitors in general visit the same location.
Who may be able to join
- All adult patients aged 18 years or older at first ED presentation in 2022 who visited the ED 4 times or more in 2022.
- All adult patients aged 18 years or older at first GPC presentation in 2022 who visited the GPC 4 times or more.
Who cannot join
- -
Trial locations and contacts
1 site in 1 country.
Netherlands1 site, 1 recruiting
- Recruiting
Zuyderland MC
Heerlen, Limburg, 6226WS
Lieke Claassen, l.claassen@zuyderland.nl
About this study
This retrospective study is part of a research line from Zuyderland Medical Centre focusing on the acute care chain. The aim of the study is to focus on the frequent visitors of the Emergency Department (ED) and bridge the gap to out-of-hours primary care.
Although the Dutch healthcare system is unique with their 24/7 accessibility to primary care, crowding within the acute care chain is a growing problem, even in the Netherlands. Patients visiting an ED multiple times a year, the so called frequent visitors are one of the contributing factors of ED crowding. This relatively small group of patients accounts for a disproportionate number of many ED visits. In the United States, it is estimated that between 4.5 and 8% of patients are responsible for almost one third of the total annual number of ED visits, by visiting the ED four or more times per year. Dutch research by vd Linden found that 0.5% of total ED patients visited their ED frequently, however, they defined frequent visitors using a threshold of 7 visits per year. In our study, the cutoff of more than four visits per year to define a frequent visitor is used.
Read more
This study aims to gain insight in who Dutch frequent visitors are, or - in other words - what their baseline characteristics are, which complaints are responsible for their healthcare seeking behavior, and do these patients also seek medical help at other places during out-of-hours like a General Practitioner Cooperative (GPC)?
Existing ED and GCP data will be used to identify patients who either visited the ED or one of the adjacent GPCs 4 times or more in one year. Using these data, this study aims to answer the following questions:
Primary objective:
- How many patients present to the ED of the Zuyderland hospital in Heerlen and Sittard 4 times or more a year and what are the characteristics of these frequent visitors of the ED?
Secondary objective:
- How many patients present to the GPC of South East Limburg 4 or more times a year and what are their characteristics of frequent visitor?
- Is there an association between the characteristics of frequent visitors of the ED of the Zuyderland hospital and subsequent (frequent) presentation at the GPC?
Read the detailed description
This study is a retrospective observational analysis of all patients aged 18 years or older at time of first presentation during the inclusion period, and who visited the ED of the Zuyderland or the GPC of Sittard-Geleen or Heerlen in the Netherlands between 1 January 2022 and 31 December 2022 and visited the ED or GPC 4 times or more during this year.
All patients presenting at the ED or GPC of Zuyderland Medical Center between 1 January 2022 and 31 December 2022, with an age of 18 years or older at time of first presentation during the inclusion period, will be included. Frequent visitors, defined as patients visiting the ED or GPC 4 times or more during these 12 months, will be identified and characterized.
The geography of south east Limburg and the locations of EDs with integrated GPC, ensure that visitors in general visit the same location.
All patients aged 18 years or older at first ED presentation in 2022 will be screened.
Data will be automatically extracted from a digital information system with a retrospective review of patients who visited the ED more than four times in 2022.
Informed consent procedure is not required in this study type (see Data Management).
Patients who have previously stated to the hospital that their data may not be used for scientific research will be excluded.
Data will be extracted from an existing database, providing a retrospective review of all ED and GPC patients. For this study, patients who visited our ED or GPC more than four times in the preceding 12 months will be included. Data will subsequently be collected from their hospital and GPC files and will be anonymized.
Descriptive statistics will be used to present the results. Differences in variables will be statistically analyzed using SPSS. Statistical tests will be chosen dependent on the number of included patients: Chi Square and Fisher Exact tests will be used with a significance p<0.05.
The following data/variables will be extracted from all patients:
- Age (at first ED or GPC visit during 2022)
- Sex
- Social security number (BSN), which only will be used to link the visitors of the ED and GPC
- Zip code area (only numbers)
- Medical history (chronical pain, oncological, heart/vascular disease, diabetes, psychiatric)
- Service characteristics (date, time of the day (day 8.00-17.00, evening 17.00-24.00), night (24.00-8.00))
- Presenting complaints
Data extracted specifically from ED patients:
- Number of ED visits during inclusion period.
- Triage category (according to the Manchester Triage System: 1-5)
- Mode of referral
- Mode of transportation to hospital (including dispatch center triage urgency)
- Destination: discharge, admission (including type of ward), referral to other clinic, death, leaving without seeing a physician.
- Presenting specialty
- Treating specialism
Data extracted specifically from GPC patients:
- Number of overall visits in 2022
- Urgency level at GPC
- Type of contact: visit, (telephone) consultation
- Treatment given at the GPC
- Referral to secondary care
- Time of contact (evening, night, weekend)
- Conditions
- Emergency Care, Acute Care Chain
- Being tested
- No intervention, observational.
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
No intervention, observational.Other
None, observational study
What is being measured
The primary outcome is the main question the study is designed to answer.
How many patients present to the ED of the Zuyderland hospital in Heerlen and Sittard 4 times or more a year and what are the characteristics of these frequent visitors of the ED?
Frequency count: Measure the exact number of ED visits for each patient over the specified time frame. Frequency count on the number of males and females. Frequency count on presenting complaints.
Measured: 1 year
Secondary outcomes (4)
How many patients present to the GPC of South East Limburg 4 times or more a year and what are their characteristics of frequent visitor?
Frequency count: Measure the exact number of GPC visits for each patient over the specified time frame. Frequency count on the number of males and females. Frequency count on presenting complaints.
Measured: 1 year
Do frequent visitors of the ED visit the GPC frequently as well?
Calculate a correlation coefficient (e.g., Pearson's correlation) between the frequency of ED visits and GPC visits.
Measured: 1 year
Do frequent visitors of the GPC visit the ED frequently as well?
Calculate a correlation coefficient (e.g., Pearson's correlation) between the frequency of ED visits and GPC visits.
Measured: 1 year
Do frequent visitors of the ED and the GPC visit those for the same reason?
Compare the reasons of presenting at the ED with reasons on presenting to the GPC with a utilization ratio.
Measured: 1 year
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted20 Jul 2023
- Study start11 Jul 2023
- Primary completion31 Dec 2024 (estimated)
- Study completion31 Dec 2024 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for Emergency CareStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Observational
- Observational model
- Cohort
- Time perspective
- Retrospective
- Enrolment
- 700 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Zuyderland Medisch Centrum
- Sponsor type
- University, hospital or other
- Responsible party
- Sponsor
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT05953467
- Sponsor's protocol ID
- METC Z20230010
- Acronym
- FEC
- Status last verified
- Feb 2024
- First submitted
- 12 Jul 2023
- Last updated
- 29 Feb 2024
- Results posted
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No
Study at a glance
From the registry record, last updated by the sponsor on 29 Feb 2024. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Healthcare Seeking Behavior of Frequent Emergency Care Visitors
- ClinicalTrials.gov ID
- NCT05953467
- Acronym / sponsor ID
- FEC / METC Z20230010
- Conditions
- Emergency Care, Acute Care Chain
- Study type
- Observational
- Recruitment status
- Unknown status
- Enrolment
- 700 participants (estimated)
- Lead sponsor
- Zuyderland Medisch CentrumUniversity, hospital or other
- Study start
- 11 Jul 2023 (actual)
- Primary completion
- 31 Dec 2024 (estimated)
- Study completion
- 31 Dec 2024 (estimated)
- First posted
- 20 Jul 2023 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
This retrospective study is part of a research line from Zuyderland Medical Centre focusing on the acute care chain. The aim of the study is to focus on the frequent visitors of the Emergency Department (ED) and bridge the gap to out-of-hours primary care.
Although the Dutch healthcare system is unique with their 24/7 accessibility to primary care, crowding within the acute care chain is a growing problem, even in the Netherlands. Patients visiting an ED multiple times a year, the so called frequent visitors are one of the contributing factors of ED crowding. This relatively small group of patients accounts for a disproportionate number of many ED visits. In the United States, it is estimated that between 4.5 and 8% of patients are responsible for almost one third of the total annual number of ED visits, by visiting the ED four or more times per year. Dutch research by vd Linden found that 0.5% of total ED patients visited their ED frequently, however, they defined frequent visitors using a threshold of 7 visits per year. In our study, the cutoff of more than four visits per year to define a frequent visitor is used.
This study aims to gain insight in who Dutch frequent visitors are, or - in other words - what their baseline characteristics are, which complaints are responsible for their healthcare seeking behavior, and do these patients also seek medical help at other places during out-of-hours like a General Practitioner Cooperative (GPC)?
Existing ED and GCP data will be used to identify patients who either visited the ED or one of the adjacent GPCs 4 times or more in one year. Using these data, this study aims to answer the following questions:
Primary objective:
- How many patients present to the ED of the Zuyderland hospital in Heerlen and Sittard 4 times or more a year and what are the characteristics of these frequent visitors of the ED?
Secondary objective:
- How many patients present to the GPC of South East Limburg 4 or more times a year and what are their characteristics of frequent visitor?
- Is there an association between the characteristics of frequent visitors of the ED of the Zuyderland hospital and subsequent (frequent) presentation at the GPC?
Detailed description
This study is a retrospective observational analysis of all patients aged 18 years or older at time of first presentation during the inclusion period, and who visited the ED of the Zuyderland or the GPC of Sittard-Geleen or Heerlen in the Netherlands between 1 January 2022 and 31 December 2022 and visited the ED or GPC 4 times or more during this year.
All patients presenting at the ED or GPC of Zuyderland Medical Center between 1 January 2022 and 31 December 2022, with an age of 18 years or older at time of first presentation during the inclusion period, will be included. Frequent visitors, defined as patients visiting the ED or GPC 4 times or more during these 12 months, will be identified and characterized.
The geography of south east Limburg and the locations of EDs with integrated GPC, ensure that visitors in general visit the same location.
All patients aged 18 years or older at first ED presentation in 2022 will be screened.
Data will be automatically extracted from a digital information system with a retrospective review of patients who visited the ED more than four times in 2022.
Informed consent procedure is not required in this study type (see Data Management).
Patients who have previously stated to the hospital that their data may not be used for scientific research will be excluded.
Data will be extracted from an existing database, providing a retrospective review of all ED and GPC patients. For this study, patients who visited our ED or GPC more than four times in the preceding 12 months will be included. Data will subsequently be collected from their hospital and GPC files and will be anonymized.
Descriptive statistics will be used to present the results. Differences in variables will be statistically analyzed using SPSS. Statistical tests will be chosen dependent on the number of included patients: Chi Square and Fisher Exact tests will be used with a significance p<0.05.
The following data/variables will be extracted from all patients:
- Age (at first ED or GPC visit during 2022)
- Sex
- Social security number (BSN), which only will be used to link the visitors of the ED and GPC
- Zip code area (only numbers)
- Medical history (chronical pain, oncological, heart/vascular disease, diabetes, psychiatric)
- Service characteristics (date, time of the day (day 8.00-17.00, evening 17.00-24.00), night (24.00-8.00))
- Presenting complaints
Data extracted specifically from ED patients:
- Number of ED visits during inclusion period.
- Triage category (according to the Manchester Triage System: 1-5)
- Mode of referral
- Mode of transportation to hospital (including dispatch center triage urgency)
- Destination: discharge, admission (including type of ward), referral to other clinic, death, leaving without seeing a physician.
- Presenting specialty
- Treating specialism
Data extracted specifically from GPC patients:
- Number of overall visits in 2022
- Urgency level at GPC
- Type of contact: visit, (telephone) consultation
- Treatment given at the GPC
- Referral to secondary care
- Time of contact (evening, night, weekend)
Study design
- Observational model
- Cohort
- Time perspective
- Retrospective
Who may qualify
- Ages
- 18 years and older
- Sex
- All
- Healthy volunteers
- Accepted
- Age groups
- Adult, Older adult
- Study population
- All patients presenting at the ED or GPC of Zuyderland Medical Center between 1 January 2022 and 31 December 2022, with an age of 18 years or older at time of first presentation during the inclusion period, will be included. Frequent visitors, defined as patients visiting the ED or GPC 4 times or more during these 12 months, will be identified and characterized. The geography of south east Limburg and the locations of EDs with integrated GPC, ensure that visitors in general visit the same location.
Key inclusion criteria (2 listed)
- All adult patients aged 18 years or older at first ED presentation in 2022 who visited the ED 4 times or more in 2022.
- All adult patients aged 18 years or older at first GPC presentation in 2022 who visited the GPC 4 times or more.
Key exclusion criteria (1 listed)
- -
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| No intervention, observational.None, observational study | Other | – |
Primary outcome
How many patients present to the ED of the Zuyderland hospital in Heerlen and Sittard 4 times or more a year and what are the characteristics of these frequent visitors of the ED?
Time frame: 1 year
Frequency count: Measure the exact number of ED visits for each patient over the specified time frame. Frequency count on the number of males and females. Frequency count on presenting complaints.
4 secondary outcomes
How many patients present to the GPC of South East Limburg 4 times or more a year and what are their characteristics of frequent visitor?
Time frame: 1 year
Do frequent visitors of the ED visit the GPC frequently as well?
Time frame: 1 year
Do frequent visitors of the GPC visit the ED frequently as well?
Time frame: 1 year
Do frequent visitors of the ED and the GPC visit those for the same reason?
Time frame: 1 year
Results and safety
Results are not available in the source record.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 29 Feb 2024.
- Individual participant dataSharing planned: No
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
An observational study of Emergency Care and Acute Care Chain, run by Zuyderland Medisch Centrum at 1 site in Netherlands.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 2 inclusion and 1 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: status not confirmed, as of the sponsor's last update on 29 Feb 2024. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Netherlands. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
Results are not available in the source record.
How can a doctor refer a patient or contact the research team?
Contact Lieke Claassen (0031884592802, l.claassen@zuyderland.nl), or a site near the patient. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
How many patients present to the ED of the Zuyderland hospital in Heerlen and Sittard 4 times or more a year and what are the characteristics of these frequent visitors of the ED? (time frame: 1 year). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 29 Feb 2024.