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Member Research and Reports

Member Research and Reports

Texas A&M: Analyzing Use of Multiple Emergency Departments by Frequent Users

Mr. Theodoros Giannouchos, a PhD candidate at the Texas A&M School of Public Health, recently found that multisite users were more likely to have diagnoses related to mental health, substance use and other urgent critical conditions in a new study published in Medical Care.

He and his co-authors analyzed a four-year period (2011-2014) of outpatient emergency department (ED) visits by all adult ED users with more than five visits in a year in New York, Massachusetts and Florida. The team chose these states because they have a consistent and unique patient identifier that enabled researchers to track patients across different ED sites for each of the calendar years.

They defined frequent use as greater than five visits to the ED in one year. The team eliminated patients with less than five visits in a given year as well as children because they are less likely to be responsible for deciding when and where to seek care.

Across the three states, 1,033,626 patients were frequent users and accounted for 7,613,077 ED visits. Of these frequent users, 25 percent were multisite users and they accounted for 30 percent of all ED visits.

Frequent users with at least one visit for a mental health or substance use related diagnosis were more likely to use multiple sites, accounting for 15 percent of the frequent multisite emergency department users population in New York, 18 percent in Massachusetts and 6 percent in Florida.

Findings show the need to implement integrated mental health and substance use treatment programs across health systems. They suggest that a population health perspective should be applied with multiple hospitals engaged in the effort. Also, they suggest a community-level preventative approach that might include the use of Health Information Exchange data as stronger infrastructure for mental health and substance abuse.

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