A Comprehensive View of Frequent Emergency Department Users Based on Data from a Regional HIE

Abstract

Objectives A small but significant number of patients make frequent emergency department (ED) visits to multiple EDs within a region. We have a unique health information exchange (HIE) that includes every ED encounter in all hospital systems in our region. Using our HIE we were able to characterize all frequent ED users in our region, regardless of hospital visited or payer class. The objective of our study was to use data from an HIE to characterize patients in a region who are frequent ED users (FEDUs). Methods We constructed a database from a cohort of adult patients (18 years old or older) with information in a regional HIE for a 1-year period beginning March 2012.A Patients were defined as FEDUs (those who made four or more visits during the study period) and non-FEDUs (those who made fewer than four ED visits during the study period). Predictor variables included age, race, sex, payer class, county of residence, and International Classification of Diseases, Ninth Revision (ICD-9) codes. Bivariate (χ2) and multivariate (logistic regression) analyses were performed to determine associations between predictor variables and the outcome of being an FEDU. Results The database contained 127,672 patients, 12,293 (9.6%) of whom were FEDUs. Logistic regression showed the following patient characteristics to be significantly associated with the outcome of being an FEDU: age 35 to 44 years; African American race; Medicaid, Medicare, and dual-pay payer class; and ICD-9 codes 630 to 679 (complications of pregnancy, childbirth, and puerperium), 780 to 799 (ill-defined conditions), 280 to 289 (diseases of the blood), 290–319 (mental disorders), 680 to 709 (diseases of the skin and subcutaneous tissue), 710 to 739 (musculoskeletal and connective tissueB disease), 460 to 519 (respiratory disease), and 520 to 579 (digestive disease). No significant differences were noted between men and women. Conclusions Data from an HIE can be used to describe all of the patients within a region who are FEDUs, regardless of the hospital system they visited. This information can be used to focus care coordination efforts and link appropriate patients to a medical home. Future studies can be designed to learn the reasons why patients become FEDUs, and interventions can be developed to address deficiencies in health care that result in frequent ED visits.

Characteristics and predictors of adult frequent emergency department users in the United States: A systematic literature review

“…The mean age of FEDU across studies varied from 38.7 to 51 years, and the 18 to 44 age group was the most prevalent among FEDU . Among all ED users, those in younger age groups were more likely to be FEDU compared with those who were equal to or older than 65 years of age .…”

“…One particular study compared the top 108 FEDU with more than 12 visits/year with 108 randomly assigned non‐FEDU (<4 visits/year) . The proportion of FEDU ranged from 3.8% to 16% of the overall ED users, and they accounted for 14.6% to 47% of all ED visits (Appendix ).…”

“…We identified four sources of bias within studies related to (1) strategies to deal with confounding variables (eg, selective reporting of results for studies that did not deal with confounding variables), (2) failure to use proper statistical methods, (3) sample size, or (4) valid and reliable measurement of outcomes (eg, response and recall bias for survey‐based results) (Figure ) 21‐31. The risk of bias across studies was low, since we extracted most information from studies with low risk of bias…”

Patient Navigation for Patients Frequently Visiting the Emergency Department: A Randomized, Controlled Trial

“…Up to 28% of ED visits in certain areas have been made by frequent ED users or superusers . Regardless of how superutilizers are defined, there is a general consensus that frequent ED utilizers tend to have more complex health problems, more chronic medical conditions, more mental health issues, and higher morbidity . This study proposed to determine the effectiveness of patient navigation in reducing ED visits and hospital costs in superutilizers.…”

“…Data collected from the phone surveys consisted of recording the actual number of physician visits made from the last ED visit as well as asking the patient to recall how many times they had attended a primary care visit in the past year. Additionally, the patient was given a validated, one‐question survey on the quality of the service in the ED (measured on a Likert scale 1–4 corresponding with completely disagree, mildly disagree, mildly agree, and completely agree) …”