Frequent ED Users Have Higher Utilization Rates Than Nonfrequent Users

Hemal K. Kanzaria, MD, MSc, says the study can provide hospitals and health systems with an opportunity to partner "outside of the healthcare system."

Nearly half of frequent emergency department (ED) users and two-thirds of superfrequent ED users sought mental health services, according to a University of California, San Francisco study featured in Health Affairs Monday afternoon.

Frequent ED users had higher utilization than nonfrequent ED users across every domain, according to the study, including sobering centers use, outpatient mental health services, and services targeting patients experiencing homelessness. Researchers defined frequent ED users as individuals who visit the ED at least four times per year, while superfrequent users visit at least 18 times per year.

About half of frequent ED users also had at least one mental health service visit and over a quarter had a substance abuse-related visit, while more than two-thirds of superfrequent ED users had a mental health visit and over half had a substance abuse-related visit.

The study also highlighted the fact that this patient population is experiencing high social needs, which include high rates of patients experiencing homelessness, growing interactions with the jail health system, and multiple markers to suggest that these patients have tricomorbidities, medical comorbidities, and mental health comorbidities.

Hemal K. Kanzaria, MD, MSc, an associate professor in the Department of Emergency Medicine and an affiliated faculty member at the Philip R. Lee Institute for Health Policy Studies at University of California, San Francisco (UCSF), tells HealthLeaders that frequent users of EDs often have other urgent non-medical needs as well.

Kanzaria adds that it's important to recognize that ED use doesn't happen in a vacuum and factors into the larger care continuum, so the researchers set out to examine what other services patients and accessing and how ED doctors can better coordinate care and develop partnerships to assist this "vulnerable patient population."

"This data provides [ED doctors] with an opportunity to understand the medical, behavioral health, and social needs [of patients] so we can better address them," Kanzaria says. "Health is more than just healthcare. An individual's health and population health are driven often by social factors, economic factors, as well as healthcare and the care that we can provide them in the ED. This data points to an opportunity for hospitals and health systems to partner outside of the healthcare system."

Kanzaria says some actionable items for healthcare executives would be to reduce siloes so that clinical workers don't duplicate efforts. He says that integrated data has value for hospitals, specifically so that clinical staff members can access information and recognize that ED users are also frequently seeking other social and healthcare services.

EDs are well-equipped to take care of patients with heart attacks, strokes, and traumatic injuries, Kanzaria says, but adds that these populations also deal with complex behavioral health issues.

By reducing barriers to information and further integrating data processes, Kanzaria says that many EDs around the country could benefit their patients by addressing their underlying mental health, substance abuse, and social needs. This also includes seeking assistance outside of the provider organization and partnering with community agencies that help patients.

"A lot of [this effort] is identifying and working with community partners who are already invested in addressing the social and behavioral health needs of patients," Kanzaria says. "I hope this data can be used to recognize that frequent ED users have significant needs and that these patients are coming to the ED, so we need to be set up to address those needs as well their medical comorbidities."

For his part, Kanzaria leads the social medicine team at Zuckerberg San Francisco General Hospital, which focuses on addressing patients' medical and social needs with "equal intensity."

The team has organized a multidisciplinary team that includes social workers, care coordination nurses, patient navigators, pharmacists, physicians of different backgrounds, and improvement specialists. The team works with the ED to get referrals for patients with high social needs, but also assists patients to understand what their self-identified social needs are, such as help with accessing quality food or receiving an identification card.

Kanzaria says the program has also established partnerships beyond the ED, such as linking patients to transitional housing services and providing patients with opiate addiction treatment.

Jack O'Brien is the Content Team Lead and Finance Editor at HealthLeaders, an HCPro brand.