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Understanding Yearly Visit Patterns of Repeat ED Users: Is Intervention Necessary?

This study investigates the visit patterns of frequent Emergency Department (ED) users over three years, highlighting the significant financial implications for Medicaid. Analyzing medical records from 2009 to 2011, we classified patients based on their yearly ED visit frequency. Results showed an initial cohort of 310 one-year repeaters, with subsequent decreases to 79 two-year and 40 three-year repeaters, indicating a need for targeted interventions for repeat users. Our aim is to understand why some patients continue to utilize the ED frequently while others decrease their visits over time.

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Understanding Yearly Visit Patterns of Repeat ED Users: Is Intervention Necessary?

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  1. ED Repeat Repeaters And Their Year-to-Year Visit Patterns: Is Intervention Really Needed? June Brown, Matt Albrecht, Brian Tillis, Georgia Mueller, Jonathan dela Cruz. Southern Illinois University School of Medicine, Springfield, IL 

  2. Background • Frequent ED Users = ½ of the $88 billion Medicaid dollars spent in ED • Past interventions • Case Management * • Patient education • Psych referrals • Primary Care partnership

  3. “Effectiveness Of Case Management Strategies In Reducing Emergency Department Visits In Frequent User Patient Population: Systematic Review” Kumar GS, Klein R, Emory University School of Medicine • 12 studies • 2 RCT • 8 pre/post interventions studies with historical controls • 2 age-matched controls • “Frequent User” defined from >3 visits/year to >5 visits/month • Majority of studies noted reduction in ED visits after CM implementation

  4. Do high frequency utilizers continue to visit the Emergency Department despite implementation of intervention strategies? • Our goal: to characterize high frequency ED users and their visit patterns over 3 calendar years, and to identify any natural trends in yearly visit frequency.

  5. Methods • Retrospective EMR review • All adult patients over 3-year period (Jan 1, 2009 – Dec 31, 2011) • Repeat user = >12 visits/year • Classified as one-year, two-year, or three-year repeat user

  6. Results • 310 one-year repeaters: average 16.2 visit/patient • 79 two-year repeaters: average 21.2 visits/patient • 40 three-year repeaters: average 30 visits/patient

  7. Age

  8. Payer Status

  9. Primary Care Status

  10. Chief Complaint

  11. Conclusion • 3107940 • Decrease by ¼ then ½ • Visits/patient: 16  21  30 • Highest yield = interventions targeting the repeat repeaters

  12. Future Studies • Further characterize the repeater groups • Why do the one/two year repeaters stop repeating? • Why do the three year repeaters keep repeating?

  13. Acknowledgements We would like to thank Memorial Medical Center in Springfield, Illinois for the grant that made this data collection possible.

  14. Questions?

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