Majority of frequent ER users have chronic conditions, not mental illness

Though urban legend stigmatized frequent emergency room patients as mentally ill substance users who drain the healthcare system of millions of dollars and contribute to overcrowding, most ER superusers actually have chronic diseases, according to a new study published in Health Affairs.

The majority of frequent ER users have a substantial burden of disease and display high rates of primary and specialty care use, as well as links to outpatient care, according to researchers John Billings, of NYU's Robert F. Wagner Graduate School of Public Service, and Maria C. Raven, of the University of California, San Francisco, 

Furthermore, they found that those with behavioral health conditions are only a small portion of users. 

Researchers based their findings on an analysis of 212,259 New York City residents who received emergency department care for the first time in 2007, examining each patient's eligibility, ED use, Medicaid fee-for-service spending and diagnostic history.

After analyzing the patients' medical history three years prior to the ED visit, the 12 months after the initial visit and the subsequent two years, they concluded people who revisited the emergency department multiple times were likely to have chronic conditions and many hospitalizations. They were also more likely linked to ambulatory care, which actually exceeded ED visit rates, except in patients with 10 or more visits in a year.

Billings and Raven said in the study that it is possible to use predictive modeling to identify who will become a repeat ED user and preemptively target them for interventions, however, reducing ED visits is only one aspect of a more comprehensive intervention strategy for frequent health system users.

The Center for Medicaid and CHIP Services said Medicaid "super-utilizers"--patients who accumulate large numbers of ED visits and hospital admissions that might have been prevented by inexpensive early intervention and primary care--are a relatively small group, yet they account for the majority of Medicare spending, FierceHealthcare previously reported.

To learn more:
- here's the study