ed repeat repeaters and their year-to-year visit patterns: is intervention really needed?

ED Repeat Repeaters And Their Year-to-Year Visit Patterns: Is Intervention Really Needed?

June Brown, Matt Albrecht, Brian Tillis, Georgia Mueller, Jonathan dela Cruz. Southern Illinois University School of Medicine, Springfield, IL 

Background

• Frequent ED Users = ½ of the $88 billion Medicaid dollars spent in ED

• Past interventions– Case Management *– Patient education– Psych referrals– Primary Care partnership

“Effectiveness Of Case Management Strategies In Reducing Emergency Department Visits In Frequent User

Patient Population: Systematic Review” Kumar GS, Klein R, Emory University School of Medicine

• 12 studies– 2 RCT– 8 pre/post interventions studies with historical controls– 2 age-matched controls

• “Frequent User” defined from >3 visits/year to >5 visits/month

• Majority of studies noted reduction in ED visits after CM implementation

• Do high frequency utilizers continue to visit the Emergency Department despite implementation of intervention strategies?

• Our goal: to characterize high frequency ED users and their visit patterns over 3 calendar years, and to identify any natural trends in yearly visit frequency.

Methods

• Retrospective EMR review• All adult patients over 3-year period

(Jan 1, 2009 – Dec 31, 2011)• Repeat user = >12 visits/year• Classified as one-year, two-year, or three-

year repeat user

Results

• 310 one-year repeaters: average 16.2 visit/patient

• 79 two-year repeaters: average 21.2 visits/patient

• 40 three-year repeaters: average 30 visits/patient

Age

1-Year 2-Year 3-Year0

10

20

30

40

50

60

70

18-4445-64>65

Payer Status

1-Year 2-Year 3-Year0

10

20

30

40

50

60

PrivateMedicareMedicaidSelf-Pay

Primary Care Status

1-Year 2-Year 3-Year0

10

20

30

40

50

60

70

80

90

YesNo

Chief Complaint

1-Year 2-Year 3-Year0

2

4

6

8

10

12

Respiratory/ChestAbdomen/PelvicHead/NeckBackMigraine

Conclusion

• 3107940• Decrease by ¼ then ½• Visits/patient: 16 21 30

• Highest yield = interventions targeting the repeat repeaters

Future Studies

• Further characterize the repeater groups• Why do the one/two year repeaters stop

repeating?• Why do the three year repeaters keep

repeating?

Acknowledgements

We would like to thank Memorial Medical Center in Springfield, Illinois for the grant that made this data collection possible.

Questions?