Giannouchos Theodoros V, Pirrallo Ronald G, Wright Brad
Department of Health Policy & Organization, School of Public Health, The University of Alabama at Birmingham, Birmingham, Alabama, USA.
Center for Outcomes and Effectiveness Research and Education, Heersink School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, USA.
Health Serv Res. 2025 Jun;60(3):e14430. doi: 10.1111/1475-6773.14430. Epub 2025 Jan 2.
To compare healthcare services utilization across the healthcare system between frequent and non-frequent emergency department (ED) users among Medicaid enrollees in South Carolina.
We conducted a retrospective, longitudinal study of individuals with at least one ED visit in 2017 in South Carolina and identified their healthcare services visits over 730 days (2 years) after their first ED visit. We classified individuals based on intensity of ED use: superfrequent (≥9 ED visits/year), frequent (4-8 ED visits/year), and non-frequent ED users (≤3 visits/year). We estimated differences between the three groups of ED users and non-ED hospital and office-based visits using multivariable two-part regression models.
We used statewide Medicaid claims from January 2017 to December 2019 for ED users aged 18-64 years with continuous Medicaid enrollment. We analyzed data on all frequent and superfrequent users and selected a 4:1 random sample among all non-frequent users (~half of all non-frequent users).
The study included 52,845 ED users, of whom 42,764 were non-frequent, 7677 frequent, and 2404 superfrequent users. Within 2 years from the date of their first ED visit, superfrequent ED users averaged 38.3 ED visits, frequent ED users 10.9 ED visits, and non-frequent ED users 2.6 ED visits (p < 0.001). Compared with non-frequent users, frequent and superfrequent ED users had more comorbidities and chronic conditions on average (1.6 vs. 3.5 vs. 6.4, p < 0.001). Both frequent and superfrequent users had more hospital visits beyond the ED overall (marginal effects: 0.23, 95% CI 0.18-0.27; 0.40, 95% CI 0.29-0.50), and more outpatient office visits overall (marginal effects: 4.39, 95% CI 2.52-6.27; 9.23, 95% CI 5.66-12.81), including primary care and most specialists' visits, compared with non-frequent users.
Frequent ED users utilized non-ED hospital and outpatient office-based healthcare services significantly more than non-frequent ED users. These findings can guide tailored interventions using data across the healthcare system to efficiently coordinate care, contain costs, and improve health outcomes for these individuals.
比较南卡罗来纳州医疗补助计划参保者中频繁和不频繁使用急诊科（ED）的人群在整个医疗系统中的医疗服务利用情况。
我们对2017年在南卡罗来纳州至少有一次急诊科就诊经历的个体进行了一项回顾性纵向研究，并确定了他们在首次急诊科就诊后730天（2年）内的医疗服务就诊情况。我们根据急诊科使用强度对个体进行分类：超频繁使用者（≥9次/年）、频繁使用者（4 - 8次/年）和不频繁使用者（≤3次/年）。我们使用多变量两部分回归模型估计了这三组急诊科使用者与非急诊科医院就诊和门诊就诊之间的差异。
我们使用了2017年1月至2019年12月全州范围内18 - 64岁持续参保医疗补助计划的急诊科使用者的医保理赔数据。我们分析了所有频繁和超频繁使用者的数据，并在所有不频繁使用者中选取了4:1的随机样本（约占所有不频繁使用者的一半）。
该研究纳入了52845名急诊科使用者，其中42764名是不频繁使用者，7677名是频繁使用者，2404名是超频繁使用者。从首次急诊科就诊日期起的2年内，超频繁急诊科使用者平均就诊38.3次，频繁使用者就诊10.9次，不频繁使用者就诊2.6次（p < 0.001）。与不频繁使用者相比，频繁和超频繁急诊科使用者平均合并症和慢性病更多（分别为1.6、3.5和6.4种，p < 0.001）。频繁和超频繁使用者在急诊科之外的医院就诊总体上更多（边际效应：0.23，95%置信区间为0.18 - 0.27；0.40，95%置信区间为0.29 - 0.50），门诊就诊总体上也更多（边际效应：4.39，95%置信区间为2.52 - 6.27；9.23，95%置信区间为5.66 - 12.81），包括初级保健和大多数专科医生的就诊，与不频繁使用者相比。
频繁使用急诊科的人群比不频繁使用者更多地利用了非急诊科医院和门诊医疗服务。这些发现可以指导利用整个医疗系统的数据进行针对性干预，以有效地协调护理、控制成本并改善这些人群的健康结果。
