A Comparison of Methods for Forecasting Emergency Department Visits for Respiratory Illness Using Telehealth Ontario Calls

Objectives: Anticipating increases in hospital emergency department (ED) visits for respiratory illness could help time interventions such as opening flu clinics to reduce surges in ED visits. Five different methods for estimating ED visits for respiratory illness from Telehealth Ontario calls are compared, including two non-linear modeling methods. Daily visit estimates up to 14 days in advance were made at the health unit level for all 36 Ontario health units. Methods: Telehealth calls from June 1, 2004 to March 14, 2006 were included. Estimates generated by regression, Exponentially Weighted Moving Average (EWMA), Numerical Methods for Subspace State Space Identification (N4SID), Fast Orthogonal Search (FOS), and Parallel Cascade Identification (PCI) were compared to the actual number of ED visits for respiratory illness identified from the National Ambulatory Care Reporting System (NACRS) database. Model predictor variables included Telehealth Ontario calls and upcoming holidays/weekends. Models were fit using the first 304 days of data and prediction accuracy was measured over the remaining 348 days. Results: Forecast accuracy was significantly better (p<0.0001) for the 12 Ontario health units with a population over 400,000 (75% of the Ontario population) than for smaller health units. Compared to regression, FOS produced better estimates (p=0.03) while there was no significant improvement for PCI-based estimates. FOS, PCI, EWMA and N4SID performed worse than regression over the remaining smaller health units. Conclusion: Telehealth can be used to estimate ED visits for respiratory illness at the health unit level. Non-linear modeling methods produced better estimates than regression in larger health units.