Karl Boegl, Klaus-Peter Adlassnig, Yoichi Hayashi, Thomas E Rothenfluh, Harald Leitich
Knowledge acquisition in the fuzzy knowledge representation framework of a medical consultation system
Artificial intelligence in medicine
people kidney failure receiving maintenance dialysis visit emergency department ed 3 times per year average 3 8fold often general population little known factors contribute potentially preventable ed use population identify clinical sociodemographic factors associated potentially preventable ed use among patients receiving maintenance dialysis cohort study used linked administrative health data within alberta kidney disease network identify adults aged 18 years older receiving maintenance dialysis ie hemodialysis peritoneal dialysis april 1 2010 march 31 2019 patients receiving dialysis 90 days followed cohort entry defined dialysis start date plus 90 days death outmigration province receipt kidney transplant end study followup andersen behavioral model health services used conceptual framework identify variables related health care need predisposing factors enabling factors data analyzed march 2024 rates allcause ed encounters potentially preventable ed use associated 4 kidney diseasespecific ambulatory caresensitive conditions hyperkalemia heart failure volume overload malignant hypertension calculated multivariable negative binomial regression models used examine association clinical sociodemographic factors rates potentially preventable ed use cohort included 4925 adults mean sd age 608 155 years 3071 males 624 kidney failure receiving maintenance hemodialysis 3183 patients peritoneal dialysis 1742 patients followed mean sd 25 20 years 3877 patients 34 029 allcause ed encounters 3100 95 ci 29963206 encounters per 1000 personyears 755 patients 195 1351 potentially preventable ed encounters 114 95 ci 105124 encounters per 1000 personyears compared patients nonpreventable ed encounter patients potentially preventable ed encounter likely lowest income quintile 388 vs 309 p 001 experience heart failure 468 vs 399 p 001 depression 366 vs 325 p 03 chronic pain 601 vs 549 p 01 longer duration dialysis 36 vs 26 years p 001 multivariable regression analyses potentially preventable ed use higher younger adults incidence rate ratio irr 169 95 ci 133215 aged 18 44 years patients chronic pain irr 135 95 ci 114161 greater material deprivation irr 157 95 ci 116212 history hyperkalemia irr 131 95 ci 109158 historically high ed use ie 3 ed encounters prior year irr 146 95 ci 123173 study adults receiving maintenance dialysis alberta canada among ed use 1 5 potentially preventable ed encounter reasons encounters associated psychosocial medical factors findings underscore need strategies address social determinants health avert potentially preventable ed use population