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Factors Associated With Geriatric Frequent Users of Emergency Departments

      Study objective

      Frequent users of the emergency department (ED) are often associated with increased health care costs. Limited research is devoted to frequent ED use within the increasing senior population, which accounts for the highest use of health care resources. We evaluate patient characteristics and patterns of ED use among geriatric patients.

      Methods

      This was a multicenter, retrospective, longitudinal, cohort study of ED visits among geriatric patients older than 65 years in 2013 and 2014. Logistic regression analysis was used to identify independent associations with frequent users. The setting was a nonpublic statewide database in California, which includes 326 licensed nonfederal hospitals. We included all geriatric patients within the database who were older than 65 years and had an ED visit in 2014, for a total of 1,259,809 patients with 2,792,219 total ED visits. The main outcome was frequent users, defined as having greater than or equal to 6 ED visits in a 1-year period, starting from their last visit in 2014.

      Results

      Overall, 5.7% of geriatric patients (n=71,449) were identified as frequent users of the ED. They accounted for 21.2% (n=592,407) of all ED visits. The associations of frequent ED use with the largest magnitude were patients with an injury-related visit (odds ratio 3.8; 95% confidence interval 3.8 to 3.9), primary diagnosis of pain (odds ratio 5.5; 95% confidence interval 5.4 to 5.6), and comorbidity index score greater than or equal to 3 (odds ratio 7.2; 95% confidence interval 7.0 to 7.5).

      Conclusion

      Geriatric frequent users are likely to have comorbid conditions and be treated for conditions related to pain and injuries. These findings provide evidence to guide future interventions to address these needs that could potentially decrease frequent ED use among geriatric patients.
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      References

        • Martin A.B.
        • Hartman M.
        • Benson J.
        • et al.
        National health spending in 2014: faster growth driven by coverage expansion and prescription drug spending.
        Health Aff (Millwood). 2016; 35: 150-160
        • Hsia R.Y.
        • Niedzwiecki M.
        National trends in emergency department occupancy, 2001 to 2008: effect of inpatient admissions versus emergency department practice intensity.
        Ann Emerg Med. 2012; 60: 679-686
        • Burke L.G.
        • Wild R.C.
        • Orav E.J.
        • et al.
        Are trends in billing for high-intensity emergency care explained by changes in services provided in the emergency department? an observational study among US Medicare beneficiaries.
        BMJ Open. 2018; 8: e019357
        • Morganti K.G.
        • Bauhoff S.
        • Blanchard J.C.
        • et al.
        The evolving role of emergency departments in the United States.
        Rand Health Q. 2013; 3: 3
        • Cohen S.
        The Concentration and Persistence in the Level of Health Expenditures Over Time: Estimates for the US Population 2012-2013.
        Agency for Healthcare Research & Quality, Rockville, MD2015 (Statistical Brief 481)
        • Pines J.M.
        • Mullins P.M.
        • Cooper J.K.
        • et al.
        National trends in emergency department use, care patterns, and quality of care in older adults in the United States.
        J Am Geriatr Soc. 2013; 61: 12-17
        • Greenwald P.W.
        • Estevez R.M.
        • Clark S.
        • et al.
        The ED as the primary source of hospital admission for older (but not younger) adults.
        Am J Emerg Med. 2016; 34: 943-947
        • Castillo E.M.
        • Brennan J.J.
        • Killeen J.P.
        • et al.
        Identifying frequent users of emergency department resources.
        J Emerg Med. 2014; 47: 343-347
        • Brennan J.J.
        • Chan T.C.
        • Hsia R.Y.
        • et al.
        Emergency department utilization among frequent users with psychiatric visits.
        Acad Emerg Med. 2014; 21: 1015-1022
        • Quan H.
        • Sundararajan V.
        • Halfon P.
        • et al.
        Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data.
        Med Care. 2005; 43: 1130-1139