Creating an Inclusive Definition for High Users of Inpatient Hospital Systems That Considers Different Levels of Rurality

Tomoko McGaughey, George Kephart, Utkarsh J. Dang and Paul A. Peters ()
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Tomoko McGaughey: Department of Health Sciences, Carleton University, Ottawa, ON K1S 5B6, Canada
George Kephart: Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS B3H 4R2, Canada
Utkarsh J. Dang: Department of Health Sciences, Carleton University, Ottawa, ON K1S 5B6, Canada
Paul A. Peters: Department of Health Sciences, Carleton University, Ottawa, ON K1S 5B6, Canada

IJERPH, 2025, vol. 22, issue 3, 1-21

Abstract: Multiple definitions have been used to identify individuals who are high system users (HSUs), through economic costs, frequency of use, or length of stay for inpatient care users. However, no definition has been validated to be representative of those residing in rural communities, who face unique service accessibility. This paper identifies an HSU definition for rural Canada that is inclusive of various levels of rurality, longitudinal patient experiences, and types of hospitalizations experienced. This study utilized the 2011 Canadian Census Health and Environment Cohort (CanCHEC) linkage profile to assess hospitalization experiences between 1 January 2009 and 31 December 2013. A range of common HSU indicators were compared using Cox proportional hazards modelling for multiple periods of assessment and types of admissions. The preferred definition for rural HSUs was individuals who are in the 90th percentile of unplanned hospitalization episodes for 2 of 3 consecutive years. This approach is innovative in that it includes longitudinal hospital experiences and multiple types of hospitalizations and assesses an individual’s rurality as a point of context for analysis, rather than a characteristic. These differences provide an opportunity for community characteristic needs assessment and subsequent adjustments to policy development and resource allocation to meet each rural community’s specific needs.

Keywords: high resource users; high system users; inpatient hospital care; survival analysis; health policy; rural health (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2025
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