Characteristics of Emergency Department Visits
Characteristics of Emergency Department Visits for Super-Utilizers by Payer, a statistical brief from the Healthcare Cost and Utilization Project, presents pooled 2014 emergency department (ED) data across 13 geographically dispersed States, representing approximately 28 percent of the U.S. population.
Over the last several years, health care stakeholders have paid increasing attention to issues specific to high-need, high-cost patients who constitute a very small percentage of the population but account for a disproportionally high amount of health care utilization. These patients, dubbed super-utilizers, represent a broad spectrum of demographic and clinical characteristics and socioeconomic conditions. Programs designed to improve care for super-utilizers need to be tailored to the specific needs of the different subgroups of these patients. 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.
For this report, ED super-utilizers were defined on the basis of a consistent cut-off rule of approximately two 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.
Highlights of Characteristics of Emergency Department Visits for Super-Utilizers by Payer
- 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.