Who are Frequent Users of Emergency Rooms?

A study of characteristics of frequent users

Zeida R. Kon, MPHUniversity of North Texas Health Science Center

Background

1993-2003- ER visits increased by 26%, totaling approximately 114 million visits per year

ERs reported being at or over capacity 50% of the time

Hospitals now employing cost-savings and cost-cutting strategies

Background

Contrary to common perceptions, the literature demonstrates frequent users of the ER are: Insured (publicly insured) U.S. citizens African Americans followed by Whites English as primary language Have a usual source of care

Background Cont.

Low socio-economic status Poor physical health Poor mental health Single, single parent or divorced Choose ER due to preference

(convenience)

Purpose

To explore the characteristics of individuals visiting the ER by comparing frequent users and non-frequent users

To explore definition of frequent ER users

Propose actions by hospitals and policy makers to alleviate overburdened ERs in the U.S.

Methods

Center for Studying Health System Change 2001-2002 Community Tracking Study Random-digit dialing survey in 60

randomly selected U.S. sites Sample size: 59,725

Methods Cont.

Dependent variable: ER frequency Non-frequent users: 1-2 visits Frequent users: 3+ visits

Independent variables: Socio-economic status Insurance status Usual source of care Marital status Number of children

Sociodemographic Characteristics by Frequency of ER Use

N % N %Race

White 43152 74 870 59African American 6595 11 365 25

Asian/Pacific Islander 2290 4 56 4Hispanic 6219 11 178 12

Age, years0-17 9498 17 304 21

18-34 12953 23 451 3235-64 26209 47 540 38

65 7620 14 134 9Female 29957 53 891 62Education ≤12 years 31860 56 1053 74Yearly Income, $

0-9999 5393 10 370 2710000-29999 13036 25 462 3330000-49999 11749 22 286 2150000-99999 17584 33 226 16

100000+ 3584 10 45 3Married 37409 67 675 473+ Children 5406 10 142 10

0-2 ER VISITS 3+ ER VISITS

Access and Health Characteristics by Frequency of

ER Use

N % N %Public Insurance 12764 23 542 38Private Insurance 37458 67 671 47Uninsured 6058 11 216 15Usual source of Care 49529 88 1323 93Usual source type, Office 38438 78 786 59Usual source type, ER 930 2 140 11

Usual source type, Outpatient 10082 20 396 30Physical health limit activity 10459 22 625 54Mental health limit activity 7870 16 463 40

0-2 ER VISITS 3+ ER VISITS

Multivariate Adjusted Odds Ratios (95% CI) of Frequent ER Use (3+)

Public Insurance 1.40 (1.07-1.82)Private Insurance 0.89 (0.69-1.14)Source of Care (Yes) 1.39 (1.08-1.78)ED as source of care 4.85 (3.53-6.66)Outpatient facility as source of care 1.46 (1.26-1.69)Physical limitation (Yes) 3.51 (3.07-4.00)Mental limitation (Yes) 1.48 (1.24-1.78)African American 1.74 (1.42-2.13)Hispanic 1.00 (0.78-1.29)Asian 0.92 (0.62-1.36)Female 1.76 (1.50-2.07)Age 0.57 (0.50-0.64)Education (13+) 0.70 (0.55-0.90)Married 0.70 (0.58-0.85)Number of kids (3+) 1.22 (0.88-1.69)

Discussion

Study confirms previous findings Frequent ER users more likely to be:

publicly insured have a usual source of care have low educational attainment female and single poor physical/mental health low-income

Rationale for broadening the range of frequent user visits to 3+

Policy Implications

This definition of frequent users includes a large enough population to warrant action on both the part of hospitals and policy makers Hospital:

Build permanent partnership public health, mental health and social service agencies

Community clinics Policy:

Guidelines that encourage above actions Best practices for hospitals to employ

Acknowledgements

Co-author: Jim P. Stimpson, Ph.D., Assistant Professor, University of North Texas Health Science Center