Who are Frequent Users of Emergency Rooms? A study of characteristics of frequent users Zeida R. Kon, MPH University of North Texas Health Science Center

Background ER visits increased by 26%, totaling approximately 114 million visits per year ER visits increased by 26%, totaling approximately 114 million visits per year ERs reported being at or over capacity 50% of the time ERs reported being at or over capacity 50% of the time Hospitals now employing cost-savings and cost-cutting strategies Hospitals now employing cost-savings and cost-cutting strategies

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

Background Cont. Low socio-economic status Low socio-economic status Poor physical health Poor physical health Poor mental health Poor mental health Single, single parent or divorced Single, single parent or divorced Choose ER due to preference (convenience) 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 the characteristics of individuals visiting the ER by comparing frequent users and non-frequent users To explore definition of frequent ER users To explore definition of frequent ER users Propose actions by hospitals and policy makers to alleviate overburdened ERs in the U.S. Propose actions by hospitals and policy makers to alleviate overburdened ERs in the U.S.

Methods Center for Studying Health System Change Community Tracking Study Center for Studying Health System Change Community Tracking Study Random-digit dialing survey in 60 randomly selected U.S. sites Random-digit dialing survey in 60 randomly selected U.S. sites Sample size: 59,725 Sample size: 59,725

Methods Cont. Dependent variable: ER frequency Dependent variable: ER frequency Non-frequent users: 1-2 visits Non-frequent users: 1-2 visits Frequent users: 3+ visits Frequent users: 3+ visits Independent variables: Independent variables: Socio-economic status Socio-economic status Insurance status Insurance status Usual source of care Usual source of care Marital status Marital status Number of children Number of children

Sociodemographic Characteristics by Frequency of ER Use

Access and Health Characteristics by Frequency of ER Use

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

Discussion Study confirms previous findings Study confirms previous findings Frequent ER users more likely to be: Frequent ER users more likely to be: publicly insured publicly insured have a usual source of care have a usual source of care have low educational attainment have low educational attainment female and single female and single poor physical/mental health poor physical/mental health low-income low-income Rationale for broadening the range of frequent user visits to 3+ 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 This definition of frequent users includes a large enough population to warrant action on both the part of hospitals and policy makers Hospital: Hospital: Build permanent partnership public health, mental health and social service agencies Build permanent partnership public health, mental health and social service agencies Community clinics Community clinics Policy: Policy: Guidelines that encourage above actions Guidelines that encourage above actions Best practices for hospitals to employ Best practices for hospitals to employ

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