Frequent Users of the Emergency Department on the US-Mexico Border: Determining Risk Factors to Inform Interventions

Frequent emergency department (ED) users comprise only a small percentage of ED users, but account for a disproportionately high number of ED visits. Frequent users (FUs) are defined as those who visit the ED greater than or equal to 4 times in a single year. These patients need recurring care, but are unlikely to receive the care they really need in the ED, because it is not designed to provide continuity of care. Although FUs were once thought to be majority uninsured, most studies find that they are most likely to be white, insured citizens, who have a usual source of care and a higher burden of disease. Various interventions have been tried to decrease the number of visits by FUs. Case management has the most evidence of success, measured in terms of decreasing the number of visits by FUs, but it is a very costly intervention to implement. It is recommended to tailor interventions to their socio-cultural context in order to increase likelihood of success and cost-effectiveness. ^ Unfortunately, very little data exists describing the frequent user population on the US-Mexico border. This study addresses this through a retrospective chart review of all patients visiting the county hospital’s emergency department in El Paso, TX in the year 2013. FUs were characterized by payer, visit acuity, disposition, prevalence of chronic disease, and other demographic characteristics. Logistic regression was used to determine risk factors for frequent ED use. ^ The risk factors most highly associated with frequent ED use were having Medicaid or charity payers, or having diabetes, asthma, mental illness, substance abuse, chronic kidney disease, or congestive heart failure. The increased prevalence of chronic disease is consistent with the literature. However, this study demonstrates that the majority of FUs are uninsured (66.3%), a major departure from the literature. ^ Interventions in this community should be aimed at impoverished adults with chronic diseases. A case management intervention is recommended and should focus on patients having four or more visits in a 12-month period and having at least one of the risk factors listed above. Legislation could also help decrease the number of visits by FUs by mitigating risk factors for these chronic diseases and increasing access to primary care for patients with Medicaid and charity payers.