Characteristics of Hospital and Emergency Care Super-utilizers with Multiple Chronic Conditions

L. Jeff Harris, Ilana Yonas, Pradeep S.B. Podila, Jim Wan, Teresa Waters, James Bailey

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

Background Targeted care transitions programs may improve the value of hospital-based health care. Super-utilizing patients with multiple chronic conditions (MCC) are thought to be particularly amenable to care transitions interventions. Objectives To identify characteristics, future utilization patterns, and health outcomes for super-utilizers with MCC. Methods Retrospective cohort study of patients receiving care in an urban multi-hospital system in Tennessee over 3 years. Adult patients with Medicaid or Medicare insurance, or both, MCC, and multiple hospitalizations and emergency department (ED) visits in a 6-month period were included. The primary outcome measures were numbers of hospitalizations and ED visits in the 12 months after the 6-month period of high utilization. Secondary outcomes included 30-day readmissions and discharge disposition. Results Of 1537 super-utilizing patients, 59.0% (n = 907) had at least two targeted chronic conditions. This final study cohort (n = 638) experienced a mean of 3.2 hospitalizations and 2.8 ED visits without hospitalization in the 12-month follow-up period. During follow-up, 26% experienced one or more 30-day readmission(s) within the health care system. Despite their medical complexity, 46% reported not having a regular primary care provider, and 48% had presenting pain scores ≥8/10. Only 1% of the visits to the ED were triaged as nonurgent. Conclusions Medicare and Medicaid patients with high baseline utilization and MCC experience continued high health care utilization. Patient characteristics, future utilization patterns, and health outcomes suggest the subgroup identified is an important subgroup of super-utilizers that merits attention because they may be particularly amenable to intervention.

Original languageEnglish (US)
Pages (from-to)e203-e214
JournalJournal of Emergency Medicine
Volume50
Issue number4
DOIs
StatePublished - Apr 1 2016

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Emergency Medical Services
Hospital Emergency Service
Hospitalization
Patient Transfer
Medicaid
Medicare
Cohort Studies
Multi-Institutional Systems
Patient Acceptance of Health Care
Delivery of Health Care
Urban Hospitals
Health
Insurance
Primary Health Care
Patient Care
Retrospective Studies
Outcome Assessment (Health Care)
Multiple Chronic Conditions
Pain

All Science Journal Classification (ASJC) codes

  • Emergency Medicine

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Characteristics of Hospital and Emergency Care Super-utilizers with Multiple Chronic Conditions. / Harris, L. Jeff; Yonas, Ilana; Podila, Pradeep S.B.; Wan, Jim; Waters, Teresa; Bailey, James.

In: Journal of Emergency Medicine, Vol. 50, No. 4, 01.04.2016, p. e203-e214.

Research output: Contribution to journalArticle

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