Identifying Key Drivers of Frequent Urgent Care Visits at the Massachusetts General Hospital Chelsea Healthcare Center (MGH-Chelsea)

Background: Frequent users of the emergency room are described as medically- and socially-complex and suffer from high rates of morbidity and mortality. However an over-reliance on ER services compromises continuity and coordination of care for chronically ill patients, increases the likelihood of unnecessary laboratory testing and hospital admission and overcrowds the emergency room and consequently diverts clinicians’ attention away from more acutely ill patients. There are few qualitative studies from the patient perspective about healthcare utilization in the context of frequent emergency room use. Furthermore, there is no available literature on frequent urgent care use. Methods: Eleven patient interviews were audio-taped, transcribed and qualitatively analyzed to characterize a population of frequent urgent care users and identify major themes surrounding clinical and social drivers of frequent urgent care use. Results: Eleven patient narratives were constructed surrounding illness narratives and chronic illness management, experience with primary care and experience with urgent care. Conclusion: Two main themes emerged: (1) engagement in healthcare for preventive health and chronic disease management; and (2) decision-making around seeking healthcare for urgent medical problems. Sixteen working hypotheses were generated about factors driving urgent care use