Characteristics of Medicaid enrollees with frequent ED use

Am J Emerg Med. 2013 Sep;31(9):1333-7. doi: 10.1016/j.ajem.2013.05.050. Epub 2013 Jul 11.


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 < .05) and suffer from alcohol abuse (15% vs 42%, P < .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.

MeSH terms

  • Abdominal Pain / therapy
  • Adult
  • Alcoholism / therapy
  • Chronic Disease / therapy
  • Connecticut
  • Emergency Service, Hospital / statistics & numerical data*
  • Female
  • Health Services Accessibility / statistics & numerical data
  • Humans
  • Male
  • Medicaid / statistics & numerical data*
  • Mental Disorders / therapy
  • Middle Aged
  • Retrospective Studies
  • Socioeconomic Factors
  • United States