New Report Takes First-of-Its-Kind Look at Frequent Users of New York City's Emergency Departments
Report Examines the Challenge of Super-users and Highlights Trends by City Neighborhood
A new report from the United Hospital Fund provides a first-of-its-kind examination of patterns of emergency department utilization in New York City hospitals at the individual patient level. The report examines “treat and release” patients, who account for nearly 3 million annual visits (79.6 percent of all emergency department visits). It focuses on “frequent users” (those who made three or more emergency department visits in a year) and “super-users” (the 4,147 people who made five or more visits in each of three consecutive years), contrasting them with less frequent emergency department visitors. It also identifies patient characteristics and variations in emergency department use by neighborhood across the city.
Researchers found that frequent emergency department use is associated with more hospitalizations, but not for all types of frequent users. They also noted variation in the frequent user population when broken down by age group, with the highest percentage of frequent users among 0-4 year olds. This age group also had the greatest neighborhood variation in the percentage of frequent users. Another characteristic associated with frequent emergency department users is housing instability; on average, 11 percent of all emergency department users with two or more visits experienced at least one move between neighborhoods.
Looking at super-users, the researchers found they have very different needs from those who visit emergency departments less frequently. Super-users were affected by high rates of mental illness and substance use, which accounted for 21 percent of visits. The significant incidence of asthma among super-users (11 percent of visits) underscores the importance of improving access to adequate ambulatory care. While these super-users also utilized significant amounts of inpatient hospital services, researchers found it striking that roughly 40 percent of them were not hospitalized in a given year, despite having made at least five emergency department visits.
The report Time and Again: Frequent Users of Emergency Department Services in New York City also examines the considerable variation in emergency department use by neighborhood, including almost a sevenfold difference between the lowest and highest utilization neighborhoods (13 visits per 100 people on the Upper East Side versus 83 per 100 in nearby East Harlem).
Among the other neighborhood variations identified:
- In the Bronx, six of the seven neighborhoods had use rates that were above the city average (36 visits per 100 people).
- Of Brooklyn’s 11 neighborhoods, eight had lower than average use, but three (Central Brooklyn, East New York/New Lots, and Bushwick/Williamsburg) had use rates significantly above the citywide average.
- The neighborhood West Queens, which had below-average emergency department use in its over-18 population, had the highest neighborhood rate of emergency department use for children aged 0-4 (23 percent of all emergency department visits).
- Neighborhoods in Staten Island had mostly below-average emergency department use.
“This report aims to provide policymakers and health care providers with data to inform the planning process behind developing and targeting new resources,” said Maria Raven, MD, one of the report’s authors. “We’ve identified two very different challenges to be addressed—frequent users and super-users of emergency department services, whose needs are often complex and whose social circumstances are fragile; and the high use of emergency departments citywide, with greater intensity in some neighborhoods.”
“A complex interplay of factors shapes distinct patterns of use for neighborhoods, as well as for individuals,” said co-author David Gould. “It’s easy to think that adding a new primary care provider here or there will address a range of problems, but we must also pay careful attention to a range of other considerations, including individuals’ health status, socioeconomic circumstances, and care-seeking behaviors. All those factors must be addressed.”
Time and Again: Frequent Users of Emergency Department Services in New York City was written by Maria Raven, MD, MPH, MSc, Assistant Professor of Emergency Medicine at the University of California San Francisco, and David Gould, senior vice president for program at United Hospital Fund. Produced with support from a HEAL 9 grant from the New York State Department of Health, the report is available from the Fund’s website at http://www.uhfnyc.org/publications/880847.
About the United Hospital Fund: The United Hospital Fund is a health services research and philanthropic organization whose primary mission is to shape positive change in health care for the people of New York.