Frequent Emergency Department Visitors Associated With a Pain-Discharge Diagnosis

Alexandrea O. Cronin, MPH,* Deborah J. Morton, PHD,† Jesse J. Brennan, MA,* and Edward M. Castillo, PHD, MPH*
*Department of Emergency Medicine, University of California San Diego, San Diego, California and †College of Education, Health and Human Services, California State University San Marcos, San Marcos, California Reprint Address: Alexandrea Cronin, MPH, Department of Emergency Medicine, University of California San Diego, 200 West Arbor Drive, MC8676, San Diego, CA 92103
Abstract—Background: Emergency departments (EDs) have experienced an increase in annual patient visits and length of stay over the past decade. Management of frequent-user patients with pain-related diagnoses are chal- lenging in a time-limited setting. Objective: The purpose of this study was to describe characteristics of frequent ED users with pain-related diagnoses. Methods: This was a retrospective longitudinal cohort study of hospital ED visits from two EDs in using encounters from September 2016 to August 2018. Frequent users were characterized as having four or more visits in a 1-year period and were further clas- sified into three categories based on the number of pain- related visits in the study period. Descriptive statistics and regression analysis results are reported for all demographic and clinical characteristics for index encounters, patient level data, and pain subgroups. Results: Of all patients, 11.3% (n = 5174) were identified as frequent users, account- ing for 38.9% (n = 91,114) of all ED visits. Overall, frequent pain users were more likely to be of middle age (odds ratio [OR] 1.70, 95% confidence interval [CI] 0.80–1.72), female (OR 2.43, 95% CI 1.79–3.29), have commercial insurance (OR 1.91, 95% CI 1.37–2.66), and have 10 or more ED en- counters (super user status) in a 12-month period (OR 23.66, 95% CI 17.12–32.71). Conclusion: Understanding characteristics of ED frequent users with pain-related diag- noses may inform community-based interventions designedto reduce episodic care and thereby improve care coordina- tion and management. � 2020 Elsevier Inc. All rights reserved.
, Keywords—emergency department; frequent users; pain

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