ed repeat repeaters and their year-to-year visit patterns: is intervention really needed?
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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. - PowerPoint PPT PresentationTRANSCRIPT
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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
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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
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“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
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• 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.
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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
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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
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Age
1-Year 2-Year 3-Year0
10
20
30
40
50
60
70
18-4445-64>65
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Payer Status
1-Year 2-Year 3-Year0
10
20
30
40
50
60
PrivateMedicareMedicaidSelf-Pay
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Primary Care Status
1-Year 2-Year 3-Year0
10
20
30
40
50
60
70
80
90
YesNo
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Chief Complaint
1-Year 2-Year 3-Year0
2
4
6
8
10
12
Respiratory/ChestAbdomen/PelvicHead/NeckBackMigraine
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Conclusion
• 3107940• Decrease by ¼ then ½• Visits/patient: 16 21 30
• Highest yield = interventions targeting the repeat repeaters
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Future Studies
• Further characterize the repeater groups• Why do the one/two year repeaters stop
repeating?• Why do the three year repeaters keep
repeating?
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Acknowledgements
We would like to thank Memorial Medical Center in Springfield, Illinois for the grant that made this data collection possible.
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Questions?