{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,31]],"date-time":"2025-10-31T07:57:12Z","timestamp":1761897432138,"version":"3.37.3"},"reference-count":27,"publisher":"Oxford University Press (OUP)","issue":"9-10","license":[{"start":{"date-parts":[[2021,8,28]],"date-time":"2021-08-28T00:00:00Z","timestamp":1630108800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"name":"U.S. DoD, Defense Health Agency","award":["HU0001-11-1-0023"],"award-info":[{"award-number":["HU0001-11-1-0023"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,8,28]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n               <jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>Super-utilizers (patients with 4 or more emergency department [ED] visits a year) account for 10% to 26% of all ED visits and are responsible for a growing proportion of healthcare expenditures. Patients recognize the ED as a reliable provider of acute care, as well as a timely resource for diagnosis and treatment. The value of ED care is indisputable in critical and emergent conditions, but in the case of non-urgent conditions, ED utilization may represent an inefficiency in the healthcare system. We sought to identify patient and clinical characteristics associated with ED super-utilization in a universally insured population.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Material and Methods<\/jats:title>\n                  <jats:p>We performed a retrospective cohort study using TRICARE claims data from the Military Health System Data Repository (2011-2015). We reviewed the claims data of all adult patients (aged 18-64 years) who had at least one encounter at the ED for any cause. Multivariable logistic regression was used to determine independent factors associated with ED super-utilization.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Factors associated with increased odds of ED super-utilization included Charlson Score\u2009\u22652 (adjusted odds ratio [aOR] 1.98, 95% confidence interval [CI]: 1.90-2.06), being eligible for Medicare (aOR 1.95, 95% CI: 1.90-2.01), and female sex (aOR 1.35, 95% CI: 1.33-1.37). Active duty service members (aOR 0.69, 95% CI 0.68-0.72) and beneficiaries with higher sponsor-rank (Officers: aOR 0.50, 95% CI: 0.55-0.57; Senior enlisted: aOR 0.82, 95% CI: 0.81-0.83) had lower odds of ED super-utilization. The most common primary diagnoses for ED visits among super-utilizers were abdominal pain, headache and migraine, chest pain, urinary tract infection, nausea and vomiting, and low back pain.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Risk of ED super-utilization appears to increase with age and diminished health status. Patient demographic and clinical characteristics of ED super-utilization identified in this study can be used to formulate healthcare policies addressing gaps in primary care in diagnoses associated with ED super-utilization and develop interventions to address modifiable risk factors of ED utilization.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/milmed\/usaa399","type":"journal-article","created":{"date-parts":[[2020,12,7]],"date-time":"2020-12-07T04:41:12Z","timestamp":1607316072000},"page":"e1010-e1016","source":"Crossref","is-referenced-by-count":9,"title":["Super-Utilization of the Emergency Department in a Universally Insured Population"],"prefix":"10.1093","volume":"186","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3873-6446","authenticated-orcid":false,"suffix":"MD MPH","given":"Tomas","family":"Andriotti","sequence":"first","affiliation":[{"name":"Center for Surgery and Public Health, Brigham and Women\u2019s Hospital, Harvard Medical School and Harvard T.H. Chan School of Public Health, Boston, MA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"suffix":"MD MPH","given":"Michael K","family":"Dalton","sequence":"additional","affiliation":[{"name":"Center for Surgery and Public Health, Brigham and Women\u2019s Hospital, Harvard Medical School and Harvard T.H. Chan School of Public Health, Boston, MA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"suffix":"PhD MPH","given":"Molly P","family":"Jarman","sequence":"additional","affiliation":[{"name":"Center for Surgery and Public Health, Brigham and Women\u2019s Hospital, Harvard Medical School and Harvard T.H. Chan School of Public Health, Boston, MA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"suffix":"ScD","given":"Stuart","family":"Lipsitz","sequence":"additional","affiliation":[{"name":"Center for Surgery and Public Health, Brigham and Women\u2019s Hospital, Harvard Medical School and Harvard T.H. Chan School of Public Health, Boston, MA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"suffix":"MD","given":"Muhammad Ali","family":"Chaudhary","sequence":"additional","affiliation":[{"name":"Center for Surgery and Public Health, Brigham and Women\u2019s Hospital, Harvard Medical School and Harvard T.H. Chan School of Public Health, Boston, MA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"suffix":"MD","given":"Laura","family":"Tilley","sequence":"additional","affiliation":[{"name":"Department of Surgery, Uniformed Services University, Bethesda, MD, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"suffix":"MD","given":"Peter A","family":"Learn","sequence":"additional","affiliation":[{"name":"Department of Military and Emergency Medicine, Uniformed Services University, Bethesda, MD, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"suffix":"MD, MSc","given":"Andrew J","family":"Schoenfeld","sequence":"additional","affiliation":[{"name":"Center for Surgery and Public Health, Brigham and Women\u2019s Hospital, Harvard Medical School and Harvard T.H. Chan School of Public Health, Boston, MA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"suffix":"MD MS","given":"Eric","family":"Goralnick","sequence":"additional","affiliation":[{"name":"Center for Surgery and Public Health, Brigham and Women\u2019s Hospital, Harvard Medical School and Harvard T.H. Chan School of Public Health, Boston, MA, USA"},{"name":"Department of Emergency Medicine, Brigham and Women\u2019s Hospital, Harvard Medical School, Boston, MA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2021,8,28]]},"reference":[{"volume-title":"National Hospital Ambulatory Medical Care Survey: 2016 Emergency Department Summary Tables","author":"Center for Health Statistics N","key":"2021082810410297400_R1"},{"article-title":"Trends in emergency department visits, 2006-2014","year":"2017","author":"Moore","key":"2021082810410297400_R2"},{"article-title":"The evolving role of emergency departments in the united states","year":"2013","author":"Abir","key":"2021082810410297400_R3"},{"key":"2021082810410297400_R4","doi-asserted-by":"publisher","DOI":"10.7717\/peerj.1544","article-title":"Potential impact of co-payment at point of care to influence emergency department utilization","volume":"4","author":"Baum","year":"2016","journal-title":"PeerJ"},{"issue":"12","key":"2021082810410297400_R5","doi-asserted-by":"publisher","first-page":"1324","DOI":"10.1111\/j.1553-2712.2011.01236.x","article-title":"The association between length of emergency department boarding and mortality","volume":"18","author":"Singer","year":"2011","journal-title":"Acad Emerg Med"},{"issue":"6","key":"2021082810410297400_R6","doi-asserted-by":"publisher","first-page":"605","DOI":"10.1016\/j.annemergmed.2012.10.026","article-title":"Effect of emergency department crowding on outcomes of admitted patients","volume":"61","author":"Sun","year":"2013","journal-title":"Ann Emerg Med"},{"issue":"4","key":"2021082810410297400_R7","doi-asserted-by":"publisher","first-page":"312","DOI":"10.1016\/J.CPEM.2018.12.002","article-title":"Value-based health care in the pediatric emergency department","volume":"19","author":"Roben","year":"2018","journal-title":"Clin Pediatr Emerg Med"},{"author":"Finding Medicine\u2019s Hot Spots | The New Yorker","key":"2021082810410297400_R8"},{"issue":"1","key":"2021082810410297400_R9","doi-asserted-by":"publisher","first-page":"41","DOI":"10.1016\/J.ANNEMERGMED.2011.03.007","article-title":"Effectiveness of interventions targeting frequent users of emergency departments: A systematic review","volume":"58","author":"Althaus","year":"2011","journal-title":"Ann Emerg Med"},{"issue":"4","key":"2021082810410297400_R10","doi-asserted-by":"publisher","first-page":"e203","DOI":"10.1016\/j.jemermed.2015.09.002","article-title":"Characteristics of hospital and emergency care super-utilizers with multiple chronic conditions","volume":"50","author":"Harris","year":"2016","journal-title":"J Emerg Med"},{"issue":"6","key":"2021082810410297400_R11","doi-asserted-by":"publisher","first-page":"881","DOI":"10.1377\/hlthaff.2017.0784","article-title":"Frequent emergency department users: A statewide comparison before and after affordable care act implementation affordable care act","volume":"37","author":"Mcconville","year":"2018"},{"article-title":"Characteristics of emergency department visits for super-utilizers by Payer, 2014 #221. STATISTICAL BRIEF #221","year":"2017","author":"Joanna Jiang","key":"2021082810410297400_R12"},{"issue":"1","key":"2021082810410297400_R13","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1111\/j.1526-4610.2008.01282.x","article-title":"Use of the emergency department for severe headache. A population-based study","volume":"49","author":"Friedman","year":"2009","journal-title":"Headache J Head Face Pain"},{"issue":"10","key":"2021082810410297400_R14","doi-asserted-by":"publisher","first-page":"893","DOI":"10.1097\/MLR.0000000000000796","article-title":"Persistent super-utilization of acute care services among subgroups of veterans experiencing homelessness","volume":"55","author":"Szymkowiak","year":"2017","journal-title":"Med Care"},{"issue":"1","key":"2021082810410297400_R15","doi-asserted-by":"publisher","first-page":"42","DOI":"10.1016\/j.annemergmed.2010.01.032","article-title":"Frequent users of emergency departments: the myths, the data, and the policy implications","volume":"56","author":"LaCalle","year":"2010","journal-title":"Ann Emerg Med"},{"issue":"1","key":"2021082810410297400_R16","doi-asserted-by":"publisher","DOI":"10.1186\/s12873-019-0296-4","article-title":"Costs and effects of interventions targeting frequent presenters to the emergency department: a systematic and narrative review","volume":"19","author":"Korczak","year":"2019","journal-title":"BMC Emerg Med"},{"key":"2021082810410297400_R17","doi-asserted-by":"publisher","first-page":"332","DOI":"10.1016\/J.JSS.2018.06.059","article-title":"The transition to data-driven quality metrics: determining the optimal surveillance period for complications after surgery","volume":"232","author":"Chaudhary","year":"2018","journal-title":"J Surg Res"},{"issue":"7","key":"2021082810410297400_R18","doi-asserted-by":"publisher","first-page":"679","DOI":"10.1001\/jamasurg.2018.0480","article-title":"Practical guide to surgical data sets: military health system tricare encounter data","volume":"153","author":"Schoenfeld","year":"2018","journal-title":"JAMA Surg"},{"issue":"1","key":"2021082810410297400_R19","doi-asserted-by":"publisher","first-page":"37","DOI":"10.1001\/jamasurg.2017.3132","article-title":"Defining optimal length of opioid pain medication prescription after common surgical procedures","volume":"153","author":"Scully","year":"2018","journal-title":"JAMA Surg"},{"issue":"5","key":"2021082810410297400_R20","doi-asserted-by":"publisher","first-page":"764","DOI":"10.1097\/TA.0000000000001004","article-title":"Racial disparities in emergency general surgery","volume":"80","author":"Zogg","year":"2016","journal-title":"J Trauma Acute Care Surg"},{"issue":"2","key":"2021082810410297400_R21","doi-asserted-by":"publisher","first-page":"267","DOI":"10.1097\/SLA.0000000000001958","article-title":"Association between race and postoperative outcomes in a universally insured population versus patients in the state of California","volume":"266","author":"Schoenfeld","year":"2017","journal-title":"Ann Surg"},{"issue":"11","key":"2021082810410297400_R22","doi-asserted-by":"publisher","first-page":"1141","DOI":"10.1097\/00007611-199411000-00017","article-title":"Military rank as a measure of socioeconomic status and survival from prostate cancer","volume":"87","author":"Clark","year":"1994","journal-title":"South Med J"},{"issue":"4","key":"2021082810410297400_R23","doi-asserted-by":"crossref","first-page":"320","DOI":"10.1197\/aemj.10.4.320","article-title":"Predictors and outcomes of frequent emergency department users","volume":"10","author":"Sun","year":"2003","journal-title":"Acad Emerg Med"},{"key":"2021082810410297400_R24","doi-asserted-by":"publisher","DOI":"10.4172\/2375-4273.1000204","article-title":"Impact of urgent care centers on emergency department visits","author":"Health","year":"2017"},{"issue":"1","key":"2021082810410297400_R25","doi-asserted-by":"publisher","DOI":"10.1186\/s12245-017-0157-4","article-title":"Variation in outpatient emergency department utilization in Texas Medicaid: a state-level framework for finding \u201csuperutilizers.\u201d","volume":"10","author":"Delcher","year":"2017","journal-title":"Int J Emerg Med"},{"issue":"4","key":"2021082810410297400_R26","doi-asserted-by":"publisher","first-page":"636","DOI":"10.1016\/j.amjsurg.2015.05.009","article-title":"Early hospital readmission for gastrointestinal-related complications predicts long-term mortality after pancreatectomy","volume":"210","author":"Hicks","year":"2015","journal-title":"Am J Surg"},{"issue":"12","key":"2021082810410297400_R27","doi-asserted-by":"publisher","first-page":"1337","DOI":"10.1016\/j.healthpol.2016.10.002","article-title":"Interventions to reduce emergency department utilisation: A review of reviews","volume":"120","author":"Van den Heede","year":"2016","journal-title":"Health Policy (New York)"}],"container-title":["Military Medicine"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/milmed\/article-pdf\/186\/9-10\/e1010\/40078108\/usaa399.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/milmed\/article-pdf\/186\/9-10\/e1010\/40078108\/usaa399.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,8,28]],"date-time":"2021-08-28T10:41:15Z","timestamp":1630147275000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/milmed\/article\/186\/9-10\/e1010\/5998883"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,8,28]]},"references-count":27,"journal-issue":{"issue":"9-10","published-online":{"date-parts":[[2021,8,28]]},"published-print":{"date-parts":[[2021,8,28]]}},"URL":"https:\/\/doi.org\/10.1093\/milmed\/usaa399","relation":{},"ISSN":["0026-4075","1930-613X"],"issn-type":[{"type":"print","value":"0026-4075"},{"type":"electronic","value":"1930-613X"}],"subject":[],"published-other":{"date-parts":[[2021,9,1]]},"published":{"date-parts":[[2021,8,28]]}}}