Understanding Frequent Emergency Department Use Among Primary Care Patients
| Autor: | Marigny Bratcher, Lawrence H Greenblatt, Janice Dillard, Alissa Stavig, Morgan Hardy, Kevin A. Schulman, Alex Cho |
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| Rok vydání: | 2017 |
| Předmět: |
Adult
Male Pediatrics medicine.medical_specialty Repeat visit Leadership and Management Primary care 03 medical and health sciences 0302 clinical medicine medicine Humans 030212 general & internal medicine Aged Retrospective Studies Primary Health Care business.industry 030503 health policy & services Health Policy Mental Disorders Public Health Environmental and Occupational Health Retrospective cohort study Emergency department Middle Aged Patient Acceptance of Health Care Patient Care Management Median time Emergency medicine Chronic Disease Female 0305 other medical science Population Health Management business Emergency Service Hospital |
| Zdroj: | Population health management. 21(1) |
| ISSN: | 1942-7905 |
| Popis: | Patients with high emergency department (ED) utilization are an important focus in population health management. This retrospective cohort study analyzed patterns of frequent ED use for 4087 patients enrolled at an academically-affiliated primary care clinic. For all ED visits (n = 4776), the chief complaints, admission rates, number of complaints per patient, and median time between return visits were assessed. Chart reviews were conducted for the 10 highest utilizers from each of the 3 leading complaints to help explain repeated ED use for the same complaints. Results showed that chief complaints for high utilizers were statistically similar to other patients. Nearly half (49.8%) of all ED visits among high utilizers were repeat visits for the same complaint. However, most high utilizers (85%) had 4 or more separate complaints. Their visits clustered temporally, with 55% occurring less than 30 days apart. Visits for psychiatric symptoms demonstrated the shortest time to repeat visit (median 17.5 days, interquartile range: 39.5). Abdominal pain, chest pain, and shortness of breath were the leading complaints and the leading sources of hospital admissions and repeat visits. Chart review revealed that these 3 chief complaints often were associated with a wide range of ongoing chronic conditions, confounded by substance abuse, anxiety, and treatment nonadherence. This study demonstrates an integrative method for examining patterns of ED use among high utilizers. It also highlights the complex nature of high utilization and the inherent difficulty in predicting and addressing the needs of high-utilizer patients. |
| Databáze: | OpenAIRE |
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