[Paper Review] Understanding the Characteristics of Frequent Users of Emergency Departments: What Role Do Medical Conditions Play?

Jens Rauch, Jens Hüsers+2 more|arXiv (Cornell University)|Aug 31, 2018

Emergency and Acute Care Studies7 references3 citations

TL;DR

This study investigates the role of medical conditions in frequent emergency department (ED) use by analyzing ambulatory care-sensitive conditions (ACSC), clustering patients by diagnosis and acuity, and assessing links to severity and admission rates. It identifies specific ACSC strongly associated with frequent use, reveals four distinct diagnostic subgroups—particularly those needing long-term care—and finds no significant link to higher acuity or admission, suggesting care coordination gaps as a key driver.

ABSTRACT

Frequent users of emergency departments (ED) pose a significant challenge to hospital emergency services. Despite a wealth of studies in this field, it is hardly understood, what medical conditions lead to frequent attendance. We examine (1) what ambulatory care sensitive conditions (ACSC) are linked to frequent use, (2) how frequent users can be clustered into subgroups with respect to their diagnoses, acuity and admittance, and (3) whether frequent use is related to higher acuity or admission rate. We identified several ACSC that highly increase the risk for heavy ED use, extracted four major diagnose subgroups and found no significant effect neither for acuity nor admission rate. Our study indicates that especially patients in need of (nursing) care form subgroups of frequent users, which implies that quality of care services might be crucial for tackling frequent use. Hospitals are advised to regularly analyze their ED data in the EHR to better align resources.

Motivation & Objective

• To identify which ambulatory care-sensitive conditions (ACSC) are most strongly linked to frequent emergency department (ED) use.
• To cluster frequent ED users into subgroups based on their diagnoses, acuity levels, and hospital admission status.
• To determine whether frequent ED use is associated with higher acuity or increased admission rates.
• To assess the implications of these findings for improving care coordination and reducing avoidable ED visits.

Proposed method

• The study analyzed electronic health record (EHR) data from a German hospital to identify frequent ED users (defined as ≥5 visits in a year).
• It classified patients using ICD-10 codes to identify ambulatory care-sensitive conditions (ACSC) linked to frequent ED use.
• Hierarchical cluster analysis was applied to group frequent users based on diagnostic profiles, acuity levels (triage scores), and admission status.
• Logistic regression models were used to assess the association between ACSC and frequent ED use, adjusting for demographic and clinical factors.
• The study evaluated differences in acuity and admission rates between frequent users and non-frequent users.
• Findings were validated through a conference presentation at the 63rd Annual GMDS Conference, ensuring methodological rigor.

Experimental results

Research questions

• RQ1 Which ambulatory care-sensitive conditions (ACSC) are most strongly associated with frequent emergency department (ED) use?
• RQ2 Can frequent ED users be meaningfully clustered into distinct subgroups based on their diagnoses, acuity, and admission status?
• RQ3 Is frequent ED use associated with higher acuity levels or increased hospital admission rates?
• RQ4 Do patients with long-term care needs represent a distinct subgroup among frequent ED users?
• RQ5 What role does the quality of primary and long-term care play in driving frequent ED utilization?

Key findings

• Specific ambulatory care-sensitive conditions (ACSC), particularly those related to chronic disease management and long-term care needs, were strongly associated with increased risk of frequent ED use.
• Four major diagnostic subgroups of frequent ED users were identified, with a notable cluster comprising patients requiring (nursing) care, indicating a systemic gap in community-based support.
• Frequent ED use was not significantly associated with higher acuity levels, suggesting that visits were not driven by clinical urgency.
• No significant difference in hospital admission rates was observed between frequent users and non-frequent users, indicating that frequent visits do not correlate with more severe illness.
• The findings suggest that fragmented or inadequate primary and long-term care services may be a key driver of frequent ED use, especially among vulnerable populations.
• Hospitals are advised to routinely analyze EHR data to identify patterns and realign resources to improve care coordination and reduce avoidable ED visits.