Table 3.
Factors associated with discordance between the primary diagnosis code assigned in the emergency department (ED) and the primary diagnosis code assigned at hospital discharge following an ED visit*
| Characteristics | Outcomes: discordance in identifying | ||
| Mental health or SUD (n=17 503) |
Any SUD (n=6294) |
Any mental health conditions (n=13 214) |
|
| ORs (95% CI) | |||
| Male | 0.95 (0.87 to 1.04) | 0.94 (0.79 to 1.13) | 0.96 (0.86 to 1.06) |
| Age at visit | |||
| ≥65 | Reference | Reference | Reference |
| 55–64 | 0.49 (0.42 to 0.58) | 1.24 (0.87 to 1.78) | 0.63 (0.50 to 0.79) |
| 45–54 | 0.39 (0.34 to 0.45) | 1.56 (1.11 to 2.18) | 0.85 (0.68 to 1.05) |
| 35–44 | 0.30 (0.26 to 0.35) | 1.83 (1.30 to 2.57) | 0.86 (0.70 to 1.06) |
| 25–34 | 0.27 (0.23 to 0.32) | 2.50 (1.76 to 3.56) | 0.85 (0.69 to 1.06) |
| <25 | 0.37 (0.31 to 0.45) | 2.44 (1.62 to 3.68) | 1.07 (0.84 to 1.36) |
| Ever residing in DTES† | 1.07 (0.98 to 1.18) | 0.98 (0.81 to 1.17) | 1.19 (1.08 to 1.33) |
| Homeless at time of visit‡ | 1.00 (0.91 to 1.11) | 0.88 (0.74 to 1.05) | 1.26 (1.13 to 1.41) |
| Year of visit | |||
| 2007–2011 | Reference | Reference | Reference |
| 2012–2014 | 0.71 (0.65 to 0.78) | 0.53 (0.44 to 0.63) | 1.04 (0.94 to 1.14) |
| 2015–2017 | 0.66 (0.60 to 0.73) | 0.74 (0.60 to 0.91) | 1.09 (0.98 to 1.21) |
| Day of visit | |||
| Weekday | Reference | Reference | Reference |
| Weekend | 1.22 (1.12 to 1.33) | 0.90 (0.77 to 1.05) | 1.27 (1.16 to 1.40) |
| Holiday | 1.51 (1.19 to 1.92) | 1.25 (0.76 to 2.05) | 1.47 (1.11 to 1.93) |
| Time of visit | |||
| 9:00–20.59 hours | Reference | Reference | Reference |
| 21:00–8.59 hours | 1.27 (1.17 to 1.38) | 1.06 (0.91 to 1.23) | 1.30 (1.19 to 1.42) |
| Triage acuity at ED | |||
| Semi to not urgent | Reference | Reference | Reference |
| Urgent | 0.98 (0.86 to 1.11) | 0.77 (0.58 to 1.02) | 1.19 (1.04 to 1.36) |
| Resuscitation emergency | 0.98 (0.86 to 1.12) | 0.99 (0.74 to 1.33) | 1.21 (1.05 to 1.40) |
| ED hospital | |||
| St. Paul’s Hospital | Reference | Reference | Reference |
| Lions Gate Hospital | 1.32 (1.05 to 1.66) | 0.67 (0.46 to 0.97) | 1.41 (1.07 to 1.85) |
| Mount Saint Joseph Hospital | 1.91 (1.49 to 2.44) | 0.29 (0.20 to 0.43) | 2.22 (1.44 to 3.41) |
| Other | 0.67 (0.20 to 2.23) | 0.23 (0.03 to 2.21) | 1.18 (0.36 to 3.91) |
| Richmond Hospital | 2.62 (2.21 to 3.11) | 0.62 (0.47 to 0.82) | 3.45 (2.72 to 4.36) |
| Vancouver General Hospital | 0.62 (0.57 to 0.68) | 0.99 (0.83 to 1.17) | 0.83 (0.76 to 0.91) |
| Length of ED visit | |||
| <6 hours | Reference | Reference | Reference |
| ≥6 hours | 1.17 (1.05 to 1.30) | 0.61 (0.47 to 0.79) | 1.37 (1.23 to 1.53) |
*Among visits with either hospital or ED record indicating a case.
†Determined by known postal code or homeless user of VCH services or DTES indication in CommunityMart data
‡Determined by presence of postal code V6Y2A1 (used if no fixed address or postal code in Discharge Abstract Database/EDMart data); postal code ‘XX’ (used for transient/homeless populations in Discharge Abstract Database/EDMart); postal code A0A 0A0 (assigned if no postal code for ED visit in EDMart and CommunityMart); indication of homelessness in EDMart/CommunityMart data.
DTES, Downtown Eastside; SUD, substance use disorder; VCH, Vancouver Coastal Health.
Bold indicates statistical significance of P-value<0.05.