Original Contribution Characteristics of Medicaid enrollees with frequent ED use Roberta Capp MD a, b, ⁎, Marjorie S. Rosenthal MD, MPH a, c , Mayur M. Desai PhD, MPH a, d , Lauren Kelley MSW, MPA e , Christopher Borgstrom BA e , Darcey L. Cobbs-Lomax MBA, MPH e , Peggy Simonette MSN, RN-BC f , Erica S. Spatz MD, MHS g a Robert Wood Johnson Foundation Clinical Scholars Program, Yale School of Medicine, New Haven, CT b Department of Emergency Medicine, Yale School of Medicine, New Haven, CT c Department of Pediatrics, Yale School of Medicine, New Haven, CT d Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT e Project Access New Haven, New Haven, CT f Yale New Haven Health System, New Haven, CT g Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT abstract article info Article history: Received 18 April 2013 Received in revised form 22 May 2013 Accepted 29 May 2013 Background: Medicaid enrollees are disproportionately represented among patients with frequent Emergency Department (ED) visits, yet prior studies investigating frequent ED users have focused on patients with all insurance types. Methods: This was a single center, retrospective study of Medicaid-insured frequent ED users (defined as ≥4 ED visits/year not resulting in hospital admission) to assess patients’ sociodemographic and clinical characteristics and evaluate differences in these characteristics by frequency of use (4-6, 7-17, and ≥18 ED visits). Results: Twelve percent (n = 1619) of Medicaid enrollees who visited the ED during the 1-year study period were frequent ED users, accounting for 38% of all ED visits (n = 10,337). Most frequent ED users (n = 1165, 72%) had 4-6 visits; 416 (26%) had 7-17 visits, and 38 (2%) had ≥18 visits. Overall, 67% had a primary care provider and 56% had at least one chronic medical condition. The most common ED diagnosis among patients with 4-6 visits was abdominal pain (7%); among patients with 7-17 and ≥18 ED visits, the most common diagnosis was alcohol-related disorders (11% and 36%, respectively). Compared with those who had 4-6 visits, patients with ≥18 visits were more likely to be homeless (7% vs 42%, P b .05) and suffer from alcohol abuse (15% vs 42%, P b .05). Conclusion: One out of 8 Medicaid enrollees who visited the ED had ≥4 visits in a year. Efforts to reduce frequent ED use should focus on reducing barriers to accessing primary care. More tailored interventions are needed to meet the complex needs of adults with ≥18 visits per year. © 2013 Elsevier Inc. All rights reserved. 1. Introduction Frequent Emergency Department (ED) users, typically defined as patients with 4 or more ED visits in 1 calendar year, comprise only 8% of individuals who utilize the ED, yet are responsible for 20% of all ED visits [1]. Frequent ED users are patients with complex social needs, many of whom have mental illness and other chronic diseases [2,3]. Compared with other ED users, frequent ED users are more likely to be hospitalized and to report overall higher use of outpatient health care services [4,5]. While all insurance groups have a subpopulation of enrollees who are frequent ED users, Medicaid enrollees compose the majority of frequent ED users [3,6,7]. Policy makers and state government leaders, as well as Medicaid office directors, aware of this phenomena, are developing programs to help route Medicaid-enrolled frequent ED users to primary care offices [8,9]. Yet there are no published data examining the unique characteristics of Medicaid-enrolled frequent ED users; instead, the current literature describes frequent ED users in general, combining the Medicaid population with the uninsured, privately insured, and Medicare populations [1,2,10,11]. Differences in insurance status and type are important to consider in the context of understanding and addressing frequent ED use. Medicaid enrollees typically face more barriers to timely primary care than those with private insurance, and may have different social and health needs than other patients. Such factors may impact the type and success of interventions to reduce ED utilization [12,13]. The objectives of this study were to characterize the socio- demographic and clinical characteristics and to investigate resource utilization associated with ED visits, among a population of Medicaid enrollees with frequent ED visits to an urban hospital within 1 year. We focused on patients who had at least 4 ED visits that did not result in hospital admissions with the assumption that this population utilizes ED services for potentially less acute reasons, and thus may be more appropriate for future interventions designed to reduce ED American Journal of Emergency Medicine 31 (2013) 1333–1337 ⁎ Corresponding author. E-mail address: roberta.capp@gmail.com (R. Capp). 0735-6757/$ – see front matter © 2013 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.ajem.2013.05.050 Contents lists available at ScienceDirect American Journal of Emergency Medicine journal homepage: www.elsevier.com/locate/ajem