1. ED Repeat Repeaters And Their Year-to-Year Visit Patterns: Is Intervention Really Needed? June Brown, Matt Albrecht, Brian Tillis, Georgia Mueller, Jonathan dela Cruz. Southern Illinois University School of Medicine, Springfield, IL

2. Background Frequent ED Users = ½ of the $88 billion Medicaid dollars spent in ED Past interventions –Case Management * –Patient education –Psych referrals –Primary Care partnership

3. “Effectiveness Of Case Management Strategies In Reducing Emergency Department Visits In Frequent User Patient Population: Systematic Review” Kumar GS, Klein R, Emory University School of Medicine 12 studies –2 RCT –8 pre/post interventions studies with historical controls –2 age-matched controls “Frequent User” defined from >3 visits/year to >5 visits/month Majority of studies noted reduction in ED visits after CM implementation

4. Do high frequency utilizers continue to visit the Emergency Department despite implementation of intervention strategies? Our goal: to characterize high frequency ED users and their visit patterns over 3 calendar years, and to identify any natural trends in yearly visit frequency.

5. Methods Retrospective EMR review All adult patients over 3-year period (Jan 1, 2009 – Dec 31, 2011) Repeat user = >12 visits/year Classified as one-year, two-year, or three- year repeat user

6. Results 310 one-year repeaters: average 16.2 visit/patient 79 two-year repeaters: average 21.2 visits/patient 40 three-year repeaters: average 30 visits/patient

7. Age

8. Payer Status

9. Primary Care Status

10. Chief Complaint

11. Conclusion 310  79  40 Decrease by ¼ then ½ Visits/patient: 16  21  30 Highest yield = interventions targeting the repeat repeaters

12. Future Studies Further characterize the repeater groups Why do the one/two year repeaters stop repeating? Why do the three year repeaters keep repeating?

13. Acknowledgements We would like to thank Memorial Medical Center in Springfield, Illinois for the grant that made this data collection possible.

14. Questions?