Characteristics of Medicaid enrollees with frequent ED use

Capp, Roberta; Rosenthal, Marjorie S.; Desai, Mayur M.; Kelley, Lauren; Borgstrom, Christopher; Cobbs-Lomax, Darcey; Simonette, Peggy; Spatz, Erica S.

doi:10.1016/j.ajem.2013.05.050

Cited by 54 publications

(54 citation statements)

References 13 publications

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“…These results are similar to those found in recent studies of ED "very high users" (≥18 visits), who also tend to be middle-aged and are characterized by a high prevalence of drug and alcohol use. 8,25 Drug and alcohol use has been repeatedly shown to be strongly associated with frequent use of services in a variety of emergency settings. 8,11,22,[26][27][28][29] Thus, the disproportionately high alcohol involvement in EMS superusers is not surprising.…”

Section: Discussionmentioning

confidence: 99%

“…We found the superuser population was represented by a much higher proportion of Medicaid recipients that the average 2009 EMS population, which has important implications for state Medicaid agencies attempting to reduce expenditures. Previous studies have demonstrated that publicly insured individuals disproportionally use ambulance transport and ED services, 25,30 especially for low-acuity conditions 31 or alcohol-related disorders. 25 However, in many communities EMS personnel are left with no alternative transport destination apart from the ED.…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies have demonstrated that publicly insured individuals disproportionally use ambulance transport and ED services, 25,30 especially for low-acuity conditions 31 or alcohol-related disorders. 25 However, in many communities EMS personnel are left with no alternative transport destination apart from the ED. 32,33 Our results show that highly frequent ED users and EMS superusers had particularly high rates of alcohol involvement.…”

Section: Discussionmentioning

confidence: 99%

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EMS-STARS: Emergency Medical Services “Superuser” Transport Associations: An Adult Retrospective Study

Hall¹,

Raven²,

Hall³

et al. 2014

Prehospital Emergency Care

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Objective. Emergency medical services (EMS) "superusers" -those who use EMS services at extremely high rateshave not been well characterized. Recent interest in the small group of individuals who account for a disproportionate share of health-care expenditures has led to research on frequent users of emergency departments and other health services, but little research has been done regarding those who use EMS services. To inform policy and intervention implementation, we undertook a descriptive analysis of EMS superusers in a large urban community. In this paper we compare EMS superusers to low, moderate, and high users to characterize factors contributing to EMS use. We also estimate the financial impact of EMS superusers. Methods. We conducted a retrospective cross-sectional study based on 1 year of data from an urban EMS system. Data for all EMS encounters with patients age ≥18 years were extracted from electronic records generated on scene by paramedics. We identified demographic and clinical variables associated with levels of EMS use. EMS users were characterized by the annual number of EMS encounters: low (1), moderate (2-4), high (5-14), and superusers (≥15). In addition, we performed a financial analysis using San Francisco Fire Department of 31,462 adults generated 43,559 EMS ambulance encounters, which resulted in 39,107 transports (a 90% transport rate). Encounters for general medical reasons were common among moderate and high users and less frequent among superusers and low users, while alcohol use was exponentially correlated with encounter frequency. Superusers were significantly younger than moderate EMS users, and more likely to be male. The superuser group created a significantly higher financial burden/person than any other group, comprising 0.3% of the study population, but over 6% of annual EMS charges and reimbursements. Conclusions. In this retrospective study, adult EMS "superusers" emerged as a distinct, predominantly male population and their EMS encounters were associated with alcohol use. Continued analysis of this unique, high-cost, and frequently transported population will likely illuminate specific intervention strategies.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

EMS-STARS: Emergency Medical Services “Superuser” Transport Associations: An Adult Retrospective Study

Hall¹,

Raven²,

Hall³

et al. 2014

Prehospital Emergency Care

View full text Add to dashboard Cite

show abstract

“…The group was also more likely to be homeless. [8] 1.2 Europe A few studies on characteristics of FUs have been performed in Europe. In a study from Netherlands, including FUs aged 18 years and older, FUs represented 2% of all patients visiting EDs, and 8% of all visits to the ED were made by FUs during 2009-2013.…”

Section: Australia and Usmentioning

confidence: 99%

Characterising double frequent users in an emergency department

Raidla

Dárro

Carlson

et al. 2018

JHA

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Visits by frequent users (FUs) has been suggested as one reason for crowding in emergency departments (EDs). In this article, we identified the characteristics of double frequent users (DFUs), ≥ 8 visits during 12 months in an ED during a period of six years, in one ED in Western Sweden. The primary outcome was to characterise DFUs and find common reasons for repeatedly visiting the ED. We conducted a retrospective cohort analysis on register data covering six years of all visits. The DFUs share of all visitors to the ED was not more than 0.03% (144 individuals), but their share of visits was 2.4% (1,017 visits/year). Chest pain and abdominal pain were the most common complaints. A typical DFU is male, around 50-year-old, unemployed, non-immigrant, suffering from alcohol abuse and/or mental health conditions. The results point to the need for changing strategies in ED services towards DFUs suffering from alcohol abuse and/or mental health conditions. The ED prioritises the severely ill but lacks resources and continuity for handling chronic diseases and follow-up routines.

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“…[3] Frequent users of the ED account for a large portion of visits, up to 34% annually in the United States. [4][5][6][7] Nearly 50% of Medicare dollars are spent on providing healthcare services to ED frequent users and costs associated with subsequent visits are even higher.…”

Section: Introductionmentioning

confidence: 99%

Risk factors for frequent users of the emergency department among adults aged 55 and older

Hays

Penprase

Kridli

2018

JNEP

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Introduction: Excessive use of the emergency department (ED) is a major source of healthcare expenditure. ED frequent users, have been identified as a major contributing factor to a disporportionate amount of ED visits and costs, making up 20% to 30% of all annual visits. The aim of the study was to identify risk factors that place adults age 55 and older at risk for frequent ED use. Methods: The Transitional Care Model (TCM): Hospital Discharge Screening Criteria for High Risk Older Adults was used to identify risk factors for frequent use of ED services in adults 55 and older. Results and conclusions: A third of the sample (33%) had active behavioral and/or psychiatric issues. A majority of the sample (87%) had two or more hospitalizations within 6 months of a prior ED visit, and seventy-two percent were hospitalized within thirty days of an Emergency Department visit. Almost 70% had at least 1 chronic diagnosis of diabetes (41.5%), heart failure (35.8%), or COPD (28%). Most patients were between ages 70-85 years old and risk factors for ED frequent use included 4 or more coexisting health conditions, 6 or more prescription medications, previous hospital admissions, active behavioral and/or psychiatric issues. Identifying older adults at high risk for ED frequent use may provide earlier interventions and less reliance on ED use for care and treatment of chronic disorders.

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Characteristics of Medicaid enrollees with frequent ED use

Cited by 54 publications

References 13 publications

EMS-STARS: Emergency Medical Services “Superuser” Transport Associations: An Adult Retrospective Study

EMS-STARS: Emergency Medical Services “Superuser” Transport Associations: An Adult Retrospective Study

Characterising double frequent users in an emergency department

Risk factors for frequent users of the emergency department among adults aged 55 and older

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