Robert Wood Johnson Foundation Clinical Scholars Program, Yale School of Medicine, New Haven, CT; Department of Emergency Medicine, Yale School of Medicine, New Haven, CT.
Am J Emerg Med. 2013 Sep;31(9):1333-7. doi: 10.1016/j.ajem.2013.05.050. Epub 2013 Jul 11.
Medicaid enrollees are disproportionately represented among patients with frequent Emergency Department (ED) visits, yet prior studies investigating frequent ED users have focused on patients with all insurance types.
This was a single center, retrospective study of Medicaid-insured frequent ED users (defined as ≥4 ED visits/year not resulting in hospital admission) to assess patients' sociodemographic and clinical characteristics and evaluate differences in these characteristics by frequency of use (4-6, 7-17, and ≥18 ED visits).
Twelve percent (n = 1619) of Medicaid enrollees who visited the ED during the 1-year study period were frequent ED users, accounting for 38% of all ED visits (n = 10,337). Most frequent ED users (n = 1165, 72%) had 4-6 visits; 416 (26%) had 7-17 visits, and 38 (2%) had ≥18 visits. Overall, 67% had a primary care provider and 56% had at least one chronic medical condition. The most common ED diagnosis among patients with 4-6 visits was abdominal pain (7%); among patients with 7-17 and ≥18 ED visits, the most common diagnosis was alcohol-related disorders (11% and 36%, respectively). Compared with those who had 4-6 visits, patients with ≥18 visits were more likely to be homeless (7% vs 42%, P < .05) and suffer from alcohol abuse (15% vs 42%, P < .05).
One out of 8 Medicaid enrollees who visited the ED had ≥4 visits in a year. Efforts to reduce frequent ED use should focus on reducing barriers to accessing primary care. More tailored interventions are needed to meet the complex needs of adults with ≥18 visits per year.
在频繁光顾急诊部（ED）的患者中，医疗补助计划（Medicaid）参保者所占比例不成比例，但先前调查频繁使用 ED 的患者的研究侧重于所有保险类型的患者。
这是一项针对医疗补助计划参保的频繁 ED 使用者（定义为≥4 次/年非住院 ED 就诊）的单中心回顾性研究，旨在评估患者的社会人口统计学和临床特征，并评估按使用频率（4-6、7-17 和≥18 次 ED 就诊）对这些特征的差异。
在 1 年研究期间，到 ED 就诊的 Medicaid 参保者中有 12%（n=1619）为频繁 ED 使用者，占所有 ED 就诊的 38%（n=10337）。大多数频繁 ED 使用者（n=1165，72%）就诊 4-6 次；416 人（26%）就诊 7-17 次，38 人（2%）就诊≥18 次。总体而言，67%的患者有初级保健提供者，56%的患者至少有一种慢性疾病。就诊 4-6 次的患者最常见的 ED 诊断是腹痛（7%）；就诊 7-17 次和≥18 次的患者最常见的诊断分别是酒精相关障碍（11%和 36%）。与就诊 4-6 次的患者相比，就诊≥18 次的患者更有可能无家可归（7%比 42%，P<0.05）和患有酒精滥用（15%比 42%，P<0.05）。
每 8 名到 ED 就诊的 Medicaid 参保者中就有 1 人在一年内就诊≥4 次。减少频繁使用 ED 的努力应侧重于减少获得初级保健的障碍。需要更有针对性的干预措施来满足每年就诊≥18 次的成年人的复杂需求。
