Emergency Department High Utilizers among Family Medicine Patients

• Published in: Journal of the American Board of Family Medicine Vol. 32; no. 2; pp. 264 - 268
• Main Authors: Kirkpatrick, Stacey, Agana, Denny Fe G, Lynch, Kim, Carek, Peter J
• Format: Journal Article
• Language: English
• Published: United States 01.03.2019
• Subjects: Adult; Aged; Chronic Pain - epidemiology; Emergency Service, Hospital - statistics & numerical data; Family Practice - statistics & numerical data; Female; Health Services Accessibility - statistics & numerical data; Humans; Male; Middle Aged; Retrospective Studies; Substance-Related Disorders - epidemiology; United States; United States; Public Health; Demography; Outpatients; Medicare; Delivery of Health Care; Primary Health Care; Emergency Departments; Medicaid
• ISSN: 1557-2625; 1558-7118
• DOI: 10.3122/jabfm.2019.02.180184

Increases in emergency department (ED) use are contributing to inefficient health care spending and becoming a public health concern. Previous studies have identified characteristics of ED high utilizers aimed at designing interventions to improve efficiency. We aim to expand on these findings in a family medicine outpatient population. We conducted a retrospective analysis on a population of ED high utilizers, defined as those who had been to the ED 6 or more times in 1 year, including medical and demographic characteristics from 2015 to 2017. Compared with our source population, ED high utilizers were most commonly female, African American, or single and insured by Medicare or Medicaid. They did not have a chronic pain or substance use diagnosis, but more than half had a psychiatric condition. The only demographic characteristic that changed over time was home location from 2015 to 2017 ( < .05). Less than 10% of ED high utilizers were the same over 3 years. Most demographic characteristics did not change over time, whereas individuals did change. Interventions aimed at improving efficiency of ED use should be geared toward unchanging characteristics rather than individuals. The only demographic characteristic that did change significantly was home location that correlated in time with the availability of new EDs providing support for a theory of supply-sensitive ED use.