“Frequent and Recurrent Emergency Department Visits: A State Level Analysis for Maryland, 2017-2019”

Background: Frequent or repeat ED visits make up over 20% of the total ED visits, while frequent users constitute up to 8% of all ED users. While some studies have analyzed ED encounters over a single healthcare system, a single year or a condition, this study examines frequent and recurrent ED utilization for the state of Maryland over three years. Methods Using 2017–2019 State Emergency Department Databases (SEDD), we conducted bivariate and multivariate analyses and identified patient/community level characteristics associated with frequent (> 4 visits/year) and recurrent frequent ED users (two and three consecutive years) in Maryland. Results Of the total 5,331,843 ED visits, frequent visits were 24.4% (1,301,301) while frequent users made up 7.16% (234,973) of all ED users. Females [OR = 1.30, 95% CI 1.24, 1.36] and patients aged 21–44 [OR = 2.41, 95% CI 2.24,2.60] were more likely to visit the ED recurrently than males, children and adolescents respectively. Compared to those with private insurance and no chronic conditions, Medicaid beneficiaries were 2.41 (95% CI 2.24,2.60) and those with multiple chronic conditions was 2.34 [95% CI 2.14,2.54] times more likely to be recurrent frequent ED users respectively. The NH Blacks were 26% [95% CI 1.25,1.28] more likely to be frequent users than NH White patients while those from the lowest income quartile were 69% [95% CI 1.66,1.71] and 33% [95% CI 1.21,1.46] more likely to be frequent and recurrent frequent ED users compared to the highest income quartile. Compared to residents of large metropolitan areas, patients from micropolitan areas were 43% [95% CI 1.38,1.48] while those living further from an ED were 9% [95% CI 1.09, 1.10] were more likely to be frequent ED users. Conclusions Frequent and recurrent frequent ED users in the state of Maryland were associated with being female, 21–44 years old, NH Black, Medicaid beneficiaries, with multiple chronic conditions and reside in a lower income zip code. Frequent ED users were also more likely to reside micropolitan areas, and further from an ED facility. We propose recommendations to stakeholders to invest in care coordination and IT infrastructure, and expand community access to outpatient care.