title: Characteristics of Medicaid enrollees with frequent ED use.
abstract: BACKGROUND
  Medicaid enrollees are disproportionately represented among patients with frequent Emergency Department (ED) visits, yet prior studies investigating frequent ED users have focused on patients with all insurance types.
  
  
  METHODS
  This was a single center, retrospective study of Medicaid-insured frequent ED users (defined as ≥4 ED visits/year not resulting in hospital admission) to assess patients' sociodemographic and clinical characteristics and evaluate differences in these characteristics by frequency of use (4-6, 7-17, and ≥18 ED visits).
  
  
  RESULTS
  Twelve percent (n = 1619) of Medicaid enrollees who visited the ED during the 1-year study period were frequent ED users, accounting for 38% of all ED visits (n = 10,337). Most frequent ED users (n = 1165, 72%) had 4-6 visits; 416 (26%) had 7-17 visits, and 38 (2%) had ≥18 visits. Overall, 67% had a primary care provider and 56% had at least one chronic medical condition. The most common ED diagnosis among patients with 4-6 visits was abdominal pain (7%); among patients with 7-17 and ≥18 ED visits, the most common diagnosis was alcohol-related disorders (11% and 36%, respectively). Compared with those who had 4-6 visits, patients with ≥18 visits were more likely to be homeless (7% vs 42%, P < .05) and suffer from alcohol abuse (15% vs 42%, P < .05).
  
  
  CONCLUSIONS
  One out of 8 Medicaid enrollees who visited the ED had ≥4 visits in a year. Efforts to reduce frequent ED use should focus on reducing barriers to accessing primary care. More tailored interventions are needed to meet the complex needs of adults with ≥18 visits per year.
authors.affiliation: Robert Wood Johnson Foundation Clinical Scholars Program, Yale School of Medicine, New Haven, CT; Department of Emergency Medicine, Yale School of Medicine, New Haven, CT. Electronic address: roberta.capp@gmail.com.
authors.forename: Roberta
authors.initials: R
authors.lastname: Capp
authors.forename: Marjorie S
authors.initials: MS
authors.lastname: Rosenthal
authors.forename: Mayur M
authors.initials: MM
authors.lastname: Desai
authors.forename: Lauren
authors.initials: L
authors.lastname: Kelley
authors.forename: Christopher
authors.initials: C
authors.lastname: Borgstrom
authors.forename: Darcey L
authors.initials: DL
authors.lastname: Cobbs-Lomax
authors.forename: Peggy
authors.initials: P
authors.lastname: Simonette
authors.forename: Erica S
authors.initials: ES
authors.lastname: Spatz
mesh_terms: D015746:Abdominal Pain / Q000628:therapy; D000328:Adult; D000437:Alcoholism / Q000628:therapy; D002908:Chronic Disease / Q000628:therapy; D003237:Connecticut; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data*; D001523:Mental Disorders / Q000628:therapy; D008875:Middle Aged; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D014481:United States