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Hyper-use of the ED.

Joseph R Shiber1, Michael B Longley, Kori L Brewer

  • 1Department of Emergency Medicine, University of Central Florida, Orlando, FL 32803, USA. shiberj@bellsouth.net

The American Journal of Emergency Medicine
|June 6, 2009
PubMed
Summary
This summary is machine-generated.

Older patients with a history of cardiovascular, genitourinary, or psychiatric conditions frequently use emergency departments (EDs). These hyper-users (HU) show similar access to primary medical doctors (PMDs) compared to general ED populations.

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Area of Science:

  • Emergency Medicine
  • Health Services Research
  • Patient Demographics

Background:

  • High-frequency emergency department (ED) utilization, defined as one or more visits per month, represents a significant burden on healthcare resources.
  • Understanding the characteristics of patients with frequent ED visits is crucial for developing targeted interventions and improving healthcare delivery.
  • This study focuses on identifying the distinct demographic and clinical profiles of hyper-users (HU) within the ED population.

Purpose of the Study:

  • To characterize the population exhibiting hyper-use of emergency department (ED) services (averaging ≥1 visit/month).
  • To compare this hyper-user (HU) cohort with the general ED population.
  • To identify specific characteristics associated with hyper-utilization of EDs.

Main Methods:

  • Retrospective cohort study conducted at a teaching hospital from January 2001 to December 2004.
  • Identified a hyper-user (HU) cohort (n=49) with >35 visits and compared them to a randomly selected non-HU cohort (n=50).
  • Compared cohorts based on age, sex, insurance, primary medical doctor (PMD) access, dwelling location, chief complaint, comorbidities, and disposition.

Main Results:

  • The HU cohort was significantly older (mean age 49.45 years) than the non-HU cohort (mean age 37.32 years; P < .0001).
  • No significant differences were observed in sex, insurance coverage, PMD access, dwelling location, or disposition between the HU and non-HU groups.
  • Univariate logistic regression identified prior cardiovascular, genitourinary, or psychiatric diseases as predictors of hyper-use.

Conclusions:

  • Hyper-users (HU) of emergency departments are older and more likely to have a history of cardiovascular, genitourinary, and psychiatric conditions.
  • Despite frequent ED visits, HU patients demonstrated similar access to primary medical doctors (PMDs) and hospital admission rates compared to non-HU patients.
  • These findings suggest that targeted interventions for specific comorbidities may help reduce ED hyper-utilization.