Characteristics of Emergency Department Visits for Super-Utilizers by Payer, 2014

From HCUP:

Highlights
    • Emergency department (ED) super-utilizers were defined as those patients with the highest number of ED visits in 2014, by payer: four or more visits for privately insured patients aged 1-64 years or Medicare patients aged 65 years and older; six or more visits for Medicaid or Medicare patients aged 1-64 years.
    • In 2014, although super-utilizers constituted a relatively small proportion of all patients seen in the ED (2.6 to 6.1 percent, depending on the payer-age group), they accounted for a large share of all ED visits (10.5 to 26.2 percent).
    • Among Medicare patients aged 65 years and older, those with three or more chronic conditions constituted 33.3 percent of all ED visits among super-utilizers compared with 26.7 percent of ED visits among other patients.
    • ED super-utilizers accounted for 15 to 34 percent of all ED visits for abdominal pain and 13 to 29 percent of all ED visits for back pain.
    • ED super-utilizers aged 65 years and older accounted for 19 percent of all ED visits for urinary tract infections, 16 percent of ED visits for nonspecific chest pain, and 14 percent of ED visits for superficial injury.
  • Super-utilizers under age 65 years accounted for 19 to 40 percent of all ED visits for headaches.

This HCUP Statistical Brief extends AHRQ’s earlier work on super-utilizers by shifting focus from hospital inpatient stays to emergency department (ED) visits. In this Statistical Brief, we limited our analysis to ED visits among patients who were treated in the ED and then released from the ED, transferred to another type of nonhospital health facility, or died in the ED. Patients who were treated in the ED and then admitted to the same or a different hospital for inpatient services were not included, because they represent a different type of patient (e.g., in terms of condition severity or treatment needs). The earlier HCUP Statistical Briefs that focused on inpatient stays included admitted patients who were initially treated in the ED.

For this report, ED super-utilizers were defined on the basis of a consistent cut-off rule of approximately 2 standard deviations above the mean number of ED visits during 2014, applied to the statistical distribution specific to each payer and age group:

  • Medicare aged 65+ years: four or more ED visits per year
  • Medicare aged 1-64 years: six or more ED visits per year
  • Private insurance aged 1-64 years: four or more ED visits per year
  • Medicaid aged 1-64 years: six or more ED visits per year

This Statistical Brief presents pooled 2014 ED data across 13 geographically dispersed States, representing approximately 28 percent of the U.S. population. Patient demographics, resource use, and outcomes of ED visits for super-utilizers are compared with visits for other patients by primary expected payer (Medicare, private insurance, and Medicaid). The five most common first-listed diagnoses for ED visits are also identified for these super-utilizers. Differences greater than 20 percent between estimates are noted in the text.

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