title: Characteristics of Hospital and Emergency Care Super-utilizers with Multiple Chronic Conditions.
abstract: BACKGROUND
  Targeted care transitions programs may improve the value of hospital-based health care. Super-utilizing patients with multiple chronic conditions (MCC) are thought to be particularly amenable to care transitions interventions.
  
  
  OBJECTIVE
  To identify characteristics, future utilization patterns, and health outcomes for super-utilizers with MCC.
  
  
  METHODS
  Retrospective cohort study of patients receiving care in an urban multi-hospital system in Tennessee over 3 years. Adult patients with Medicaid or Medicare insurance, or both, MCC, and multiple hospitalizations and emergency department (ED) visits in a 6-month period were included. The primary outcome measures were numbers of hospitalizations and ED visits in the 12 months after the 6-month period of high utilization. Secondary outcomes included 30-day readmissions and discharge disposition.
  
  
  RESULTS
  Of 1537 super-utilizing patients, 59.0% (n = 907) had at least two targeted chronic conditions. This final study cohort (n = 638) experienced a mean of 3.2 hospitalizations and 2.8 ED visits without hospitalization in the 12-month follow-up period. During follow-up, 26% experienced one or more 30-day readmission(s) within the health care system. Despite their medical complexity, 46% reported not having a regular primary care provider, and 48% had presenting pain scores ≥8/10. Only 1% of the visits to the ED were triaged as nonurgent.
  
  
  CONCLUSIONS
  Medicare and Medicaid patients with high baseline utilization and MCC experience continued high health care utilization. Patient characteristics, future utilization patterns, and health outcomes suggest the subgroup identified is an important subgroup of super-utilizers that merits attention because they may be particularly amenable to intervention.
authors.affiliation: Center for Health Systems Improvement, University of Tennessee Health Science Center, Memphis, Tennessee; Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee.
authors.forename: L Jeff
authors.initials: LJ
authors.lastname: Harris
authors.affiliation: Center for Health Systems Improvement, University of Tennessee Health Science Center, Memphis, Tennessee; Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee.
authors.forename: Ilana
authors.initials: I
authors.lastname: Graetz
authors.affiliation: Center for Health Systems Improvement, University of Tennessee Health Science Center, Memphis, Tennessee; School of Public Health, The University of Memphis, Memphis, Tennessee.
authors.forename: Pradeep S B
authors.initials: PS
authors.lastname: Podila
authors.affiliation: Center for Health Systems Improvement, University of Tennessee Health Science Center, Memphis, Tennessee; Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee.
authors.forename: Jim
authors.initials: J
authors.lastname: Wan
authors.affiliation: Center for Health Systems Improvement, University of Tennessee Health Science Center, Memphis, Tennessee; Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee.
authors.forename: Teresa M
authors.initials: TM
authors.lastname: Waters
authors.affiliation: Center for Health Systems Improvement, University of Tennessee Health Science Center, Memphis, Tennessee; Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee; Division of General Internal Medicine, Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee.
authors.forename: James E
authors.initials: JE
authors.lastname: Bailey
mesh_terms: D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D000071069:Multiple Chronic Conditions; D012189:Retrospective Studies; D013714:Tennessee
keywords: care transitions; hot-spotting; multiple chronic conditions; readmissions; utilization