title: High-frequency users of emergency department care.
abstract: BACKGROUND
  The heterogeneous group of patients who frequently use the Emergency Department (ED) have been of interest in public health care reform debate, but little is known about the subgroup of the highest frequency users.
  
  
  OBJECTIVE
  We sought to describe the demographic and utilization characteristics of patients who visit the ED 20 or more times per year.
  
  
  METHODS
  We retrospectively studied patients who visited a large, urban ED over a 1-year period, identifying all patients using the department 20 or more times. Age, gender, insurance, psychosocial factors, chief complaint, and visit disposition were described for all visits. Inferential tests assessed associations between demographic variables, insurance status, and admission rates.
  
  
  RESULTS
  Of the 59,172 unique patients to visit the ED between December 1, 2009 and November 30, 2010, 31 patients were identified as high-frequency ED users, contributing 1.1% of all visits. Patients were more likely to be 30-59 years of age (52%), stably insured (81%), and have at least one significant psychosocial cofactor (65%). Their admission rate was 15%, as compared to 21% for all other patients.
  
  
  CONCLUSIONS
  High-frequency users are patients with significant psychiatric and social comorbidities. Given their small proportion of visits, lower admission rates, and favorable insurance status, the impact of high-frequency users of the ED may be out of proportion to common perceptions.
authors.affiliation: Department of Emergency Medicine, Mount Sinai School of Medicine, New York, NY 10029, USA.
authors.forename: Eduardo J
authors.initials: EJ
authors.lastname: LaCalle
authors.forename: Elaine J
authors.initials: EJ
authors.lastname: Rabin
authors.forename: Nicholas G
authors.initials: NG
authors.lastname: Genes
mesh_terms: D000328:Adult; D017677:Age Distribution; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006703:Ill-Housed Persons / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data; D006278:Medicare / Q000706:statistics & numerical data; D001523:Mental Disorders / Q000453:epidemiology; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data; D012189:Retrospective Studies; D017678:Sex Distribution; D014481:United States / Q000453:epidemiology