Factors associated with high-utilization in a safety net setting.

Area of Science:

• Health Services Research
• Social Determinants of Health
• Patient Outcomes

Background:

• High-utilizer patients (HUPs) drive significant healthcare costs.
• Social determinants of health (SDOH) are understudied in HUPs.
• Understanding HUPs' SDOH is key to improving their health and reducing costs.

Purpose of the Study:

• Define the HUP population at a safety-net hospital.
• Identify differences between HUPs and non-HUPs.
• Analyze demographic, medical, and social factors influencing HUP healthcare use and mortality.

Main Methods:

• Case-control study with retrospective chart review.
• 247 HUPs (≥3 admissions/year) vs. 247 matched controls (1-2 admissions/year).
• Multivariable logistic regression to assess factors associated with HUP status and mortality.

Main Results:

• Medicaid/Medicare, recreational drug use, and homelessness were associated with HUP status.
• HUPs had a significantly higher mortality rate (22.6%) compared to controls (8.9%).

Conclusions:

• Social factors are strongly linked to high healthcare utilization.
• Non-clinical patient factors must be integrated into HUP care strategies.
• Addressing SDOH can improve HUP health and reduce healthcare spending.