Past Frequent Emergency Department Use Predicts Mortality

Publisher: Health Affairs, vol. 38, no. 1 (subscription required)
Jan 08, 2019
Authors
Matthew J. Niedzwiecki, Hemal K. Kanzaria, Juan Carlos Montoy, Renee Y. Hsia, and Maria C. Raven

Key Findings:

  • Frequent visits to the ED in the past year were predictive of mortality among nonelderly patients in both the short and longer terms. This finding held even after researchers controlled for patient demographic characteristics, insurance status, and comorbidities.
  • Frequent ED use up to four years before death was a significant predictor of longer-term (two-year) mortality. The association between frequent ED use and two-year mortality was stronger for more recent frequent use and diminished as the documented frequent use was further back in time.
  • Unlike previous studies, this study did not find strong evidence that ED super users (those with at least 18 visits annually) had lower mortality rates than patients with 4 to 17 visits. Findings suggest that super users were similar to patients with 4 to 17 visits per year, and that super use might not indicate lower acuity or medical need.

This groundbreaking study in the January issue of Health Affairs finds that frequent emergency department (ED) users are at higher risk for mortality compared with similar patients receiving emergency care. The research, which examined California data, suggests that providers should view frequent ED use as a marker of serious medical needs and as an independent risk factor for death in the short-term (within 7 days) and longer-term (within 2 years).