Hardy Morgan, Cho Alex, Stavig Alissa, Bratcher Marigny, Dillard Janice, Greenblatt Lawrence, Schulman Kevin
1 Department of Undergraduate Medical Education, Duke University School of Medicine , Durham, North Carolina.
2 Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine , Durham, North Carolina.
Popul Health Manag. 2018 Feb;21(1):24-31. doi: 10.1089/pop.2017.0030. Epub 2017 Jun 13.
Patients with high emergency department (ED) utilization are an important focus in population health management. This retrospective cohort study analyzed patterns of frequent ED use for 4087 patients enrolled at an academically-affiliated primary care clinic. For all ED visits (n = 4776), the chief complaints, admission rates, number of complaints per patient, and median time between return visits were assessed. Chart reviews were conducted for the 10 highest utilizers from each of the 3 leading complaints to help explain repeated ED use for the same complaints. Results showed that chief complaints for high utilizers were statistically similar to other patients. Nearly half (49.8%) of all ED visits among high utilizers were repeat visits for the same complaint. However, most high utilizers (85%) had 4 or more separate complaints. Their visits clustered temporally, with 55% occurring less than 30 days apart. Visits for psychiatric symptoms demonstrated the shortest time to repeat visit (median 17.5 days, interquartile range: 39.5). Abdominal pain, chest pain, and shortness of breath were the leading complaints and the leading sources of hospital admissions and repeat visits. Chart review revealed that these 3 chief complaints often were associated with a wide range of ongoing chronic conditions, confounded by substance abuse, anxiety, and treatment nonadherence. This study demonstrates an integrative method for examining patterns of ED use among high utilizers. It also highlights the complex nature of high utilization and the inherent difficulty in predicting and addressing the needs of high-utilizer patients.
急诊室（ED）利用率高的患者是人群健康管理的重要关注对象。这项回顾性队列研究分析了在一家学术附属初级保健诊所登记的4087名患者频繁使用急诊室的模式。对于所有急诊就诊（n = 4776），评估了主要症状、住院率、每位患者的症状数量以及复诊之间的中位时间。对三大主要症状中每类症状的10位最高利用率患者进行了病历审查，以帮助解释因相同症状而反复急诊就诊的情况。结果显示，高利用率患者的主要症状在统计学上与其他患者相似。高利用率患者中近一半（49.8%）的急诊就诊是因相同症状的复诊。然而，大多数高利用率患者（85%）有4种或更多不同的症状。他们的就诊在时间上较为集中，55%的就诊间隔时间不到30天。因精神症状就诊的复诊时间最短（中位时间17.5天，四分位间距：39.5）。腹痛、胸痛和呼吸急促是主要症状，也是住院和复诊的主要原因。病历审查显示，这三大主要症状通常与多种持续的慢性病有关，还受到药物滥用、焦虑和治疗不依从的影响。本研究展示了一种检查高利用率患者急诊使用模式的综合方法。它还凸显了高利用率的复杂性以及预测和满足高利用率患者需求的内在困难。
