The most frequent ED patients carry insurance and a significant burden of disease.
OBJECTIVE
The objective of this study was to determine factors that impact emergency department (ED) utilization among the most frequent ED users.


METHODS
This prospective observational study consisting of questionnaires was conducted in an urban ED with an annual census of 95000 patients. A convenience sample of the top 1% of adult frequent users (≥9 ED visits in the previous 12 months) was enrolled from February 2009 to March 2010. Patients were excluded because of intoxication, altered mental status, or acute psychosis.


RESULTS
A total of 115 patients were enrolled, with an average age of 44 years and median number of 22 ±13 ED visits in the preceding 12 months. Seventy-eight percent of frequent users reported adequate health insurance coverage, and 75% reported one or more chronic medical conditions. Despite the high rates of insured patients, 75% identified the ED as their primary health care site. Half of the cohort had 2 or more hospital admissions over the past 12 months, of which 24% were patients with end-stage renal disease.


CONCLUSIONS
The top 1% of frequent users usually had adequate health insurance and primary care access but were burdened by chronic conditions and frequent hospital admissions. Such patients may require more extensive coordinated medical management to decrease ED utilization.
Department of Emergency Medicine, Henry Ford Hospital, Detroit, MI 48202, USA. jmiller6@hfhs.org
Joseph B
JB
Miller
Emily
E
Brauer
Hima
H
Rao
Kevin
K
Wickenheiser
Sharmistha
S
Dev
Ronald
R
Omino
Stephanie
S
Stokes-Buzzelli
D000328:Adult; D002908:Chronic Disease; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility; D006786:Hospitals, Urban; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data*; D008297:Male; D011446:Prospective Studies; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires