Hotspotters in Washoe County, Nevada: Analysis of frequent emergency department users

Description/Issue: The state of Nevada ranks 46^th in the nation for numbers of primary care doctors, family care specialists and pediatricians. 21% of Nevadans live at or below the federal poverty level and 23% of Nevadans do not have health insurance. These factors create access barriers to getting healthcare in Nevada.  One of the ways people without health insurance access healthcare and other services is through emergency departments (ED). Oftentimes EDs are the most expensive way to access the healthcare system and are used as a safety net.

Methods: Data was based on Nevada State UB-10 hospital discharges submitted to Nevada State Division of Healthcare Finance and Policy. Patient's demographics, unique admission ID, diagnoses, charges, length of staying and other healthcare proving variables are included in the UB-10 system.  Patient's unique IDs were used to identify those patients who visited the ED more than 12 times per year (hot spotters). SAS-9.3 software, Cross-tab frequency distributions and Chi-square tests were used for data analyses.

Results: The analysis of the data from 2009-2013 identified a group of 953 unique individuals that visited an ED 12 or more times in a given 12 month period. This group of 953 unique individuals accounted for 20,844 ED admissions from 2009 through 2012 and accumulated a total of over $65 million dollars in hospital charges during this time. The most common diagnoses were headache, abdominal pain, and lumbago. More women (58%) than men (41%) were seen and the majority of the cohort (78%) was white, 8% were Hispanic, and 6% were African American. 90% of the cohort were between the ages of 18 and 65. Importantly, 46% of the cohort lived in one of three different zip codes in Washoe County, all of them in downtown Reno, an economically poor area of the county. Insurance status of the study population showed 28% was Self-Pay/Uninsured, 19% was covered by Medicaid, another 19% was covered by Medicare, and 10% were covered by Nevada Medicaid HMO. These groups accounted for $46.6 million dollars in hospital charges, out of the total of $65 million.

Conclusion: A relatively small number of people in Washoe County, Nevada contribute to a large number of ED admissions and disproportionate healthcare costs. This could be due to lack of health insurance, multiple chronic health conditions, or lack of access to primary care providers or mental health professionals.  The burden of these costs is often distributed to other patients in the healthcare system. Increasing access to primary care, health insurance, mental health services, urgent care centers, a nurse health phone-line, and other interventions that could be targeted to hotspotter areas may reduce inappropriate use of emergency departments.