Factors associated with persistent multiyear frequent emergency department use

BackgroundAlthough frequent emergency department (ED) users have been widely studied in cross-sectional settings, there is some evidence suggesting that most frequent ED users do not remain frequent users over multiple consecutive years. The objective of this study was to explore the association between persistent multiyear frequent ED use and individuals' characteristics. MethodsA retrospective analysis using the Healthcare Cost and Utilization Project State Emergency Department Databases (2012-2017) for individuals aged 18-59 who visited any ED in Florida, Massachusetts and New York was conducted. Multivariable regression models were used to estimate the association between persistent frequent ED use over time (& GE;4 ED visits in each data year) and individuals' characteristics and clinical factors compared with non-persistent frequent users (& GE;4 ED visits only in the baseline year). ResultsThe databases for the three states included 3.3 million patients, who accounted for 4.5 million ED visits in the baseline year (2012). Of those, 3.2% of patients were frequent ED users (& GE;4 visits) accounting for 13.2% of all ED visits in the baseline year. Longitudinal follow-up revealed that 14.9% (15 617) of frequent users in 2012 remained persistently frequent ED users for 2-3 consecutive years and 3.6% (3774) for 4-6 consecutive years. Persistent frequent ED users differed significantly from non-persistent frequent ED users; they had more ED visits in the index year, were more likely to have no health insurance or public health insurance coverage, and had a higher prevalence of chronic conditions and comorbidities, and more ED visits for less medically urgent conditions. ConclusionDifferences exist between persistent and non-persistent frequent ED users that should be considered when implementing interventions designed to improve health outcomes and curtail healthcare expenditures generated by the broad population of frequent ED users.