{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T12:11:27Z","timestamp":1753877487053,"version":"3.41.2"},"reference-count":30,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2020,1,31]],"date-time":"2020-01-31T00:00:00Z","timestamp":1580428800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,2,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>High-cost, high-need users are defined as patients who accumulate large numbers of emergency department visits and hospital admissions that might have been prevented by relatively inexpensive early interventions and primary care. This phenomenon has not been previously described in HIV-infected individuals.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We analyzed the health records of HIV-infected individuals using scheduled or unscheduled inpatient or outpatient health care in St James\u2019s Hospital, Dublin, Ireland, from October 2014 to October 2015.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Twenty-two of 2063 HIV-infected individuals had a cumulative length of stay &amp;gt;30 days in the study period. These individuals accrued 99 emergency department attendances and 1581 inpatient bed days, with a direct cost to the hospital of &amp;gt;\u20ac1 million during the study period. Eighteen of 22 had potentially preventable requirements for unscheduled care. Two of 18 had a late diagnosis of HIV. Sixteen of 18 had not been successfully engaged in outpatient HIV care and presented with consequences of advanced HIV. Fourteen of 16 of those who were not successfully engaged in care had \u22651 barrier to care (addiction, psychiatric disease, and\/or homelessness).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>A small number of HIV-infected individuals account for a high volume of acute unscheduled care. Intensive engagement in outpatient care may prevent some of this usage and ensuing costs.<\/jats:p><\/jats:sec>","DOI":"10.1093\/ofid\/ofaa037","type":"journal-article","created":{"date-parts":[[2020,1,31]],"date-time":"2020-01-31T13:13:03Z","timestamp":1580476383000},"source":"Crossref","is-referenced-by-count":2,"title":["High-Cost, High-Need Users of Acute Unscheduled HIV Care: A Cross-Sectional Study"],"prefix":"10.1093","volume":"7","author":[{"given":"Conor","family":"Grant","sequence":"first","affiliation":[{"name":"St James\u2019s Hospital, Dublin, Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Colm","family":"Bergin","sequence":"first","affiliation":[{"name":"St James\u2019s Hospital, Dublin, Ireland"},{"name":"Trinity College, Dublin, Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sarah","family":"O\u2019Connell","sequence":"first","affiliation":[{"name":"Limerick Regional Hospital, Limerick, Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John","family":"Cotter","sequence":"first","affiliation":[{"name":"St James\u2019s Hospital, Dublin, Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0842-425X","authenticated-orcid":false,"given":"Cl\u00edona","family":"N\u00ed Cheallaigh","sequence":"first","affiliation":[{"name":"St James\u2019s Hospital, Dublin, Ireland"},{"name":"Trinity College, Dublin, Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2020,1,31]]},"reference":[{"key":"2020022507093454200_CIT0001","doi-asserted-by":"crossref","first-page":"e007771","DOI":"10.1136\/bmjopen-2015-007771","article-title":"Multimorbidity and healthcare utilisation among high-cost patients in the US Veterans Affairs Health Care System","volume":"5","author":"Zulman","year":"2015","journal-title":"BMJ Open"},{"key":"2020022507093454200_CIT0002","doi-asserted-by":"crossref","first-page":"166","DOI":"10.1001\/jamainternmed.2016.8021","article-title":"Effect of an intensive outpatient program to augment primary care for high-need Veterans Affairs patients: a randomized clinical trial","volume":"177","author":"Zulman","year":"2017","journal-title":"JAMA Intern Med"},{"key":"2020022507093454200_CIT0003","doi-asserted-by":"crossref","first-page":"e024724","DOI":"10.1136\/bmjopen-2018-024724","article-title":"Evaluation of the intensive outpatient clinic: study protocol for a prospective study of high-cost, high-need patients in the University of Utah Health system","volume":"9","author":"Bannon","year":"2019","journal-title":"BMJ Open"},{"key":"2020022507093454200_CIT0004","doi-asserted-by":"crossref","DOI":"10.17226\/27115","volume-title":"Effective Care for High-Need Patients.","author":"Long","year":"2017"},{"key":"2020022507093454200_CIT0005","doi-asserted-by":"crossref","first-page":"845","DOI":"10.1001\/jamainternmed.2018.0823","article-title":"Approach for achieving effective care for high-need patients","volume":"178","author":"Figueroa","year":"2018","journal-title":"JAMA Intern Med"},{"key":"2020022507093454200_CIT0006","doi-asserted-by":"crossref","first-page":"2572","DOI":"10.1001\/jama.2013.7103","article-title":"Contribution of preventable acute care spending to total spending for high-cost Medicare patients","volume":"309","author":"Joynt","year":"2013","journal-title":"JAMA"},{"key":"2020022507093454200_CIT0007","doi-asserted-by":"crossref","first-page":"e0149179","DOI":"10.1371\/journal.pone.0149179","article-title":"Who are the high-cost users? 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