Characteristics of Frequent Emergency Department Users among Dual Eligibles Aged 65 and over in California's In-Home Supportive Services Program

Objective: To examine characteristics of frequent emergency department (ED) users among dual eligibles aged 65 and over in California's In-Home Supportive Services (IHSS) program.

Methods: The analyses of the study were based on linked Medicare and Medi-Cal (California's Medicaid program) claims data from 18 of 58 California counties. Frequent ED users were defined as three or more ED visits in a year. A Multinomial Logistic Regression model was conducted to determine characteristics associated with frequent ED users based on the three categories in Andersen's Behavioral Model of Health Services Utilization (predisposing, need and enabling).

Results: A large number of older dual eligibles (N=9,821, 25%) used the EDs. More than 20 percent of the ED users were frequent ones (n=1987). Factors associated with frequent ED use included being African-American or Hispanic and a younger age. Depression, fracture/injury and coronary heart disease were the three leading causes for frequent ED use. Enabling factors associated with frequent ED use included MSSP use and living in a medium-sized county. Older dual eligibles having additional income to share the cost of IHSS service were less likely to be frequent ED users.

Conclusion: Frequent ED users were more likely to be African-Americans and Hispanics, and to have heavy disease burden. Differences in patterns of frequent ED use suggest the importance of managing complex health care conditions in frail and low income population.