Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health

Introduction: Frequent emergency department (ED) users, particularly those with high rates of use, often experience complex social determinants of health (SDOH) that contribute to their repeated visits and may lead to adverse health outcomes. Our objective in this study was to characterize the needs most commonly affecting this population, which may support the creation of tailored interventions with a higher chance of success.

Methods: This was a retrospective analysis of patients evaluated by an ED social medicine team in a large urban academic ED from May 2021–December 2023. Patients were identified either via frequent ED use (patients with the 10 highest number of visits each month) or referred by ED staff. We assigned 11 categories of medical, mental health, and social needs through chart review and team documentation. The primary outcome was the identification of distinct need-based subgroups among patients with high ED use, using latent class analysis of documented social, mental health, and medical needs.

Results: Of the 181 patients, representing approximately 0.4% of the ED patient population, 149 (82.3%) were frequent ED users, with a median of 14 ED visits annually (IQR 8-21), while the rest were referred by ED staff (median 2 visits (1-4.25). The majority were non-Hispanic Black (159, 87.8%) and publicly insured (163, 90.0%). The most common needs were related to housing instability (116, 64.1%) and limited access to outpatient care (112, 61.9%). Latent class analysis revealed four distinct subgroups, all of which included limited access to outpatient care: 1) primarily limited access to outpatient care (40, 22.1%); 2) housing instability and other basic needs (27, 14.9%); 3) housing instability, psychotic disorders, other basic needs, and inability to live independently (23, 12.7%); and 4) housing instability, substance use, and psychotic disorders (91, 50.3%).

Conclusion: This analysis identified four distinct need-based subgroups of  frequent ED users, suggesting the need for tailored, multifaceted interventions. Housing instability, psychiatric illness, substance use, and outpatient care access were prevalent across groups, underscoring the importance of including resources for these basic needs in any programs developed for this population. Findings support prioritizing coordinated care models, particularly those that incorporate housing, behavioral health, substance use resources, and navigation support, for this vulnerable population.