How to identify and divert persistent, frequent ER users

Emergency-Room-Sign
Frequent ER visitors' use often persists over time, but multidisciplinary care coordination can reduce visits, new research suggests.

A core group of patients who frequent the emergency department, sometimes called superusers, are likely to continue the behavior for many years. But it's hard to predict which patients fall into that category in order to intervene.

New research could help hospitals not only predict which patients will become persistent frequent ER users but also help change their behavior through coordinated, multidisciplinary care programs.

The team looked at data on a group of more than 170,000 frequent ER visitors in California, including more than 1.1 million visits from 2005 to 2015. They found that a small but significant group of patients used the ER persistently through the entire study period. 

RELATED: Kaiser Permanente Northwest takes new approach to redirect ER superusers 

Of those who were frequent ER visitors in 2005, 30.5% were also frequent users in 2006. In 2008, 16.5% were still frequent users. It wasn't until 2015 that the number had dropped to 1.5%.  

The best predictor of frequent ER use was the intensity of use, according to the study, and not necessarily specific socioeconomic or clinical factors. Persistent ER use was not consistent, and declined over time for most patients in the study. 

RELATED: Illinois hospital offers housing to curb ER superusers 

A second Health Affairs study looked at the impact that coordinated, multidisciplinary care models can have on reducing superusers' visits to the emergency room. Researchers at the University of Colorado monitored patients enrolled in the university's Bridges to Care (B2C) program, which is an ER-initiated, community-based program. 

The study included data on more than 17,900 people. In the six months following B2C intervention, ED visits dropped 29.7% and hospitalizations decreased by 30% compared to those who did not participate in the intervention. 

RELATED: 5 steps to effective care management 

In tandem with the decrease in hospital care, visits to primary care providers increased by 123.2% compared to the control group. The study shows the need for providers of different disciplines to work together on this issue, the researchers said. 

"Outreach in the ED is key to enrolling and engaging high utilizers," they said. "For a program such as B2C to be effective, behavioral health services must be provided to high utilizers to ensure comprehensive, multidisciplinary care."