• Stacey Kirkpatrick, Denny Fe G Agana, Kim Lynch, and Peter J Carek.
• From University of Florida College of Medicine, Gainesville, FL (SK); Department of Community Health and Family Medicine ((DFGA, KL, PC), Department of Epidemiology (DFGA), University of Florida, Gainesville. slk.kirkpatrick@gmail.com.
• J Am Board Fam Med. 2019 Mar 1; 32 (2): 264-268.

BackgroundIncreases in emergency department (ED) use are contributing to inefficient health care spending and becoming a public health concern. Previous studies have identified characteristics of ED high utilizers aimed at designing interventions to improve efficiency. We aim to expand on these findings in a family medicine outpatient population.MethodsWe conducted a retrospective analysis on a population of ED high utilizers, defined as those who had been to the ED 6 or more times in 1 year, including medical and demographic characteristics from 2015 to 2017.ResultsCompared with our source population, ED high utilizers were most commonly female, African American, or single and insured by Medicare or Medicaid. They did not have a chronic pain or substance use diagnosis, but more than half had a psychiatric condition. The only demographic characteristic that changed over time was home location from 2015 to 2017 (P < .05). Less than 10% of ED high utilizers were the same over 3 years.ConclusionsMost demographic characteristics did not change over time, whereas individuals did change. Interventions aimed at improving efficiency of ED use should be geared toward unchanging characteristics rather than individuals. The only demographic characteristic that did change significantly was home location that correlated in time with the availability of new EDs providing support for a theory of supply-sensitive ED use.© Copyright 2019 by the American Board of Family Medicine.

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