title: Emergency Department Frequent Utilization for Non-Emergent Presentments: Results from a Regional Urban Trauma Center Study.
abstract: OBJECTIVE
  First, to test a model of the drivers of frequent emergency department utilization conceptualized as falling within predisposing, enabling, and need dimensions. Second, to extend the model to include social networks and service quality as predictors of frequent utilization. Third, to illustrate the variation in thresholds that define frequent utilization in terms of the number of emergency department encounters by the predictors within the model.
  
  
  METHODS
  Primary data collection over an eight week period within a level-1 trauma urban hospital's emergency department.
  
  
  METHODS
  Representative randomized sample of 1,443 adult patients triaged ESI levels 4-5. Physicians and research staff interviewed patients as they received services. Relationships with the outcome variable, utilization, were tested using logistic regression to establish odds-ratios.
  
  
  RESULTS
  70.6 percent of patients have two or more, 48.3 percent have three or more, 25.3 percent have four or more, and 14.9 percent have five or more emergency department visits within 12 months. Factors associated with frequent utilization include gender, race, poor mental health, mental health drugs, prescription drug abuse, social networks, employment, perceptions of service quality, seriousness of condition, persistence of condition, and previous hospital admittance.
  
  
  CONCLUSIONS
  Interventions targeting associated factors will change global emergency department encounters, although the mutability varies. Policy interventions to address predisposing factors such as substance abuse or access to mental health treatment as well as interventions that speak to enabling factors such as promoting the resiliency of social networks may result in decreased frequency of emergency department utilization.
authors.affiliation: Virginia Modeling, Analysis and Simulation Center, Old Dominion University, Suffolk, Virginia, United States of America.
authors.forename: Joshua G
authors.initials: JG
authors.lastname: Behr
authors.affiliation: Zaragoza Logistics Center, Massachusetts Institute of Technology, Zaragoza, España.
authors.forename: Rafael
authors.initials: R
authors.lastname: Diaz
mesh_terms: D000328:Adult; D004630:Emergencies / Q000453:epidemiology*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006301:Health Services Needs and Demand; D006801:Humans; D007407:Interviews as Topic; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011897:Random Allocation; D012307:Risk Factors; D012944:Social Support; D014193:Trauma Centers / Q000706:statistics & numerical data*; D055815:Young Adult