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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  . Background.

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ed repeat repeaters and their year to year visit patterns is intervention really needed

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 

background
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
slide3

“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
slide4

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.
methods
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
results
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
conclusion
Conclusion
  • 3107940
  • Decrease by ¼ then ½
  • Visits/patient: 16  21  30
  • Highest yield = interventions targeting the repeat repeaters
future studies
Future Studies
  • Further characterize the repeater groups
  • Why do the one/two year repeaters stop repeating?
  • Why do the three year repeaters keep repeating?
acknowledgements
Acknowledgements

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