Potentially Avoidable Emergency Department Utilization by Persons With Psoriatic Arthritis and Radiographic Axial Spondyloarthritis: A Population-Based Cohort Study
Bibliographic record
Abstract
OBJECTIVE: Greater accessibility to ambulatory services may mitigate emergency department (ED) presentations for lower acuity issues. This study examined ED utilization patterns for individuals with psoriatic arthritis (PsA) and radiographic axial spondyloarthritis (r-axSpA) in a universal access healthcare setting. METHODS: Linked population-based administrative datasets in Alberta, Canada (fiscal years 2007/2008-2017/2018) were assessed for yearly ED visit frequency, timing, triage acuity, most responsible diagnoses, and disposition for persons with PsA and r-axSpA. RESULTS: A total of 4984 individuals with PsA and 14,690 with r-axSpA had 53,174 and 124,037 unique ED encounters, respectively. On average, 47.6% of persons with PsA and 35.7% with r-axSpA accessed the ED annually. Low acuity encounters (triaged as less urgent or nonurgent) were common, comprising 44.2% and 50.3% of visits for PsA and r-axSpA cohorts, respectively. Infection and injury were the most common responsible diagnoses. Presentations for inflammatory arthritis were infrequent (1.2% and 2% for PsA and r-axSpA cohorts, respectively), with no significant differences by sex or urbanicity. Rural patients had nearly twice the mean number of visits per year, had a higher frequency of less acute presentations, and were admitted less often in both disease cohorts. Sex differences included differential timing of presentation to EDs, and female patients with PsA had a lower frequency of admission relative to male patients with PsA. CONCLUSION: ED use for less urgent and nonurgent health concerns was frequent for persons with PsA and r-axSpA, particularly in rural settings. These data can inform tailored health service delivery including access solutions for persons residing in rural areas.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".