Risk Factors for Persistent Frequent Emergency Department Use in Medicare Beneficiaries

Erin M. Colligan, Jesse M. Pines, Elizabeth Ann Colantuoni, Benjamin Howell, Jennifer Wolff

Research output: Contribution to journalArticle

Abstract

Study objective: We examine factors associated with persistent frequent emergency department (ED) use during a 2-year period among Medicare beneficiaries. Methods: We conducted a retrospective, claims-based analysis of fee-for-service Medicare beneficiaries, using the Chronic Condition Data Warehouse's random 20% sample files. We used multinomial logistic regression models to compare frequent ED use (defined as 4 or more ED visits per year) with infrequent use (1 to 3 visits per year), non-ED use, and death in 2010 as a function of sociodemographic, primary care, clinical characteristics, and 2009 ED use. Results: Approximately 1.1% of Medicare beneficiaries were persistent frequent ED users, defined as experiencing frequent ED use in 2009 and 2010 consecutively. Of the 3.3% of Medicare beneficiaries who were frequent ED users in 2009, 34.3% were frequent ED users, 19.4% were non-ED users, 39.0% were infrequent ED users, and 7.4% died in 2010. Frequent ED use in 2009 was highly associated with frequent ED use in 2010 (relative risk ratio 35.2; 95% confidence interval 34.5 to 35.8). Younger age, Medicaid status, and mental illness were also strong predictors of frequent ED use. The probability of frequent ED use in 2010 was 3.4% for the total sample, but was 19.4% for beneficiaries who were frequent users in 2009 and 49.0% for beneficiaries in the youngest age group who had mental illness, Medicaid, and frequent ED use in 2009. Conclusion: Efforts to curtail frequent ED use in Medicare should focus on disabled, socially vulnerable beneficiaries.

Original languageEnglish (US)
JournalAnnals of Emergency Medicine
DOIs
StateAccepted/In press - Jul 20 2015

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Medicare
Hospital Emergency Service
Medicaid
Logistic Models
Insurance Claim Review
Fee-for-Service Plans
Primary Health Care
Age Groups

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Risk Factors for Persistent Frequent Emergency Department Use in Medicare Beneficiaries. / Colligan, Erin M.; Pines, Jesse M.; Colantuoni, Elizabeth Ann; Howell, Benjamin; Wolff, Jennifer.

In: Annals of Emergency Medicine, 20.07.2015.

Research output: Contribution to journalArticle

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abstract = "Study objective: We examine factors associated with persistent frequent emergency department (ED) use during a 2-year period among Medicare beneficiaries. Methods: We conducted a retrospective, claims-based analysis of fee-for-service Medicare beneficiaries, using the Chronic Condition Data Warehouse's random 20{\%} sample files. We used multinomial logistic regression models to compare frequent ED use (defined as 4 or more ED visits per year) with infrequent use (1 to 3 visits per year), non-ED use, and death in 2010 as a function of sociodemographic, primary care, clinical characteristics, and 2009 ED use. Results: Approximately 1.1{\%} of Medicare beneficiaries were persistent frequent ED users, defined as experiencing frequent ED use in 2009 and 2010 consecutively. Of the 3.3{\%} of Medicare beneficiaries who were frequent ED users in 2009, 34.3{\%} were frequent ED users, 19.4{\%} were non-ED users, 39.0{\%} were infrequent ED users, and 7.4{\%} died in 2010. Frequent ED use in 2009 was highly associated with frequent ED use in 2010 (relative risk ratio 35.2; 95{\%} confidence interval 34.5 to 35.8). Younger age, Medicaid status, and mental illness were also strong predictors of frequent ED use. The probability of frequent ED use in 2010 was 3.4{\%} for the total sample, but was 19.4{\%} for beneficiaries who were frequent users in 2009 and 49.0{\%} for beneficiaries in the youngest age group who had mental illness, Medicaid, and frequent ED use in 2009. Conclusion: Efforts to curtail frequent ED use in Medicare should focus on disabled, socially vulnerable beneficiaries.",
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