Resource utilization and health care charges associated with the most frequent ED users

Ondler, Cory; Hegde, Gajanan G.; Carlson, Jestin N.

doi:10.1016/j.ajem.2014.07.013

Cited by 57 publications

(81 citation statements)

References 12 publications

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“…Although previous studies have found a similarly increased likelihood in African American patients being FEDUs, 2,15,27 other studies have found either no difference or a reduced likelihood that these patients are FEDUs. 4,14,19 Because there was only a small increase in the chance that an African American patient was an FEDU (OR 1.09) and because of the conflicting reports on this variable in the literature, it is possible that some factor other than race is influencing this difference. One study suggested that factors such as socioeconomic status, chronic disease prevalence (ie, SCD), availability of care, and cultural attitudes about where to seek care influence the racial difference noted in ED use.…”

Section: Discussionmentioning

confidence: 99%

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

Saef¹,

Carr²,

Bush³

et al. 2016

Southern Medical Journal

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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.

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Section: Discussionmentioning

confidence: 99%

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

Saef¹,

Carr²,

Bush³

et al. 2016

Southern Medical Journal

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“…This group of patients, besides greatly contributing to ED overcrowding, are usually portrayed as a costly population that often abuse or misuse ED services [10]. However, no definitive data is presently available.…”

Section: Introductionmentioning

confidence: 99%

Frequent Use of Emergency Departments by the Elderly Population When Continuing Care Is Not Well Established

et al. 2016

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IntroductionThe elderly, who suffer from multiple chronic diseases, represent a substantial proportion of Emergency Department (ED) frequent users, thus contributing to ED overcrowding, although they could benefit from other health care facilities, if those were available. The aim of this study was to evaluate and characterize hospital visits of older patients (age 65 or greater) to the ED of a university teaching hospital in Rome from the 1st of January to the 31st of December 2014, in order to identify clinical and social characteristics potentially associated with “elderly frequent users”.Material and MethodsA retrospective study was performed during the calendar year 2014 (1st January 2014 – 31st December 2014) analyzing all ED admissions to the University Hospital of Rome Tor Vergata. Variables collected included age, triage code, arrival data, discharge diagnosis, and visit outcome. We performed a risk analysis using univariate binary logistic regression models.ResultsA total number of 38,016 patients accessed the ED, generating 46,820 accesses during the study period, with an average of 1.23 accesses for patient. The elderly population represented a quarter of the total ED population and had an increased risk of frequent use (OR 1.5: CI 1.4–1.7) and hospitalization (OR 3.8: CI 3.7–4). Moreover, they showed a greater diagnostic complexity, as demonstrated by the higher incidence of yellow and red priority codes compared to other ED populations (OR 3.1: CI 2.9–3.2).DiscussionOlder patients presented clinical and social characteristics related to the definition of “elderly frail frequent users”. The fact that a larger number of hospitalizations occurred in such patients is indirect evidence of frailty in this specific population, suggesting that hospital admissions may be an inappropriate response to frailty, especially when continued care is not established.ConclusionEnhancement of continuity of care, establishment of a tracking system for those who are at greater risk of visiting the ED and evaluating fragile individuals should be the highest priority in addressing ED frequent usage by the elderly.

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“…They also used more tobacco and had more intolerance to medications than the average ED patient. [6] Another US study showed higher frequencies of mental health diseases, abuse of alcohol and drugs among FUs compared to the average ED patient. The results showed that 77.3% of frequent visitors, i.e.…”

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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Resource utilization and health care charges associated with the most frequent ED users

Cited by 57 publications

References 12 publications

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

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

Frequent Use of Emergency Departments by the Elderly Population When Continuing Care Is Not Well Established

Characterising double frequent users in an emergency department

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