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Frequent emergency department utilization across four common chronic conditions
In the United States, approximately 10% of patients account for 70% of healthcare expenditures. Frequent emergency department (ED) utilization contributes to overall high costs of healthcare, however relatively little is known about these patients.
Objectives:
The purpose of this analysis was to characterize frequent ED utilizers in an urban, academic hospital and explore their healthcare utilization across chronic conditions.
Methods:
We conducted a retrospective chart review of 305 frequent ED utilizers treated between October 2013 and October 2014. Eligible patients had four or more ED visits annually and participated in an ED-based care coordination pilot initiative.
Results:
Most patients were female (61%) and average age was 45 (SD=14.9) years. 81% of patients were African American and 12% were Hispanic. Public insurance covered 78% of patients. The primary chronic medical conditions identified were sickle cell disease (SCD) (19%), hypertension (HTN) (65%), diabetes (27%), and asthma (17%). Many patients had multiple conditions.
ED visits and admissions were highest for SCD patients, with 12.1 (SD=10.3) and 7.8 (SD=6.5), respectively. HTN patients had 8.1 (SD=8.5) visits on average, and 4.3 (SD=4.8) admissions. ED visits and admissions for asthma patients were 7.9 (SD=7.6) and 4.2 (SD=3.4), respectively. On average, diabetic patients had 6.8 (SD=5.5) visits and 4.0 (SD=4.6) admissions.
Conclusions:
Four common chronic conditions- SCD, HTN, diabetes, and asthma- characterized this patient population. While all conditions had significant utilization, SCD patients had the highest, followed by patients with HTN, asthma, and diabetes. There is room for cost saving and care coordination for these patients.
Learning Areas:
Chronic disease management and preventionClinical medicine applied in public health
Learning Objectives:
Describe demographic characteristics of frequent emergency department utilization.
Identify the magnitude of health care utilization for frequent emergency department utilizers.
Compare the magnitude of health care utilization across chronic conditions.
Keyword(s): Utilization, Chronic Disease Management and Care
Qualified on the content I am responsible for because: My interest and experience with public health research, specifically research in the setting of the emergency department, has spanned over several years. I have worked to develop strategies to better coordinate care for patients who frequently utilize the emergency department. These strategies have taken many forms, including quality improvement initiatives, retrospective chart reviews, and qualitative focus groups and in-depth interviews with patients.
Any relevant financial relationships? No
I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.