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Our study, published in Health Services Research, shows that team-based care can help reduce visits among patients who often come to the emergency department.
Terms such as “frequent flyer” or “high utilizer” have been used to categorize and stigmatize people who make frequent visits to the emergency department (ED). Some providers consider these patients unreachable, assuming they will be back soon no matter what medical treatments they get.
Getting care primarily from the ED can mean higher costs for everyone, overcrowding, longer waits, exposure to infection risk, and weaker patient-provider relationships.
Our research, published in the journal Health Services Research, finds that an interdisciplinary, team-based approach to addressing these patients’ medical and social needs can help reduce the number of times they come to the ED.
Studies estimate that about 4-8% of patients visit the ED four or more times per year, making up 21-28% of all ED visits.
Nobody wakes up in the morning thinking, “I’m going to the ED today.” Many things can lead someone to the ED; not all health problems can be solved with medicine. Studies show that about 80% of health outcomes are driven by factors outside of the health system. As providers, we want to understand how to best help patients who may:
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Not knowing where else to get care.
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Have unmet behavioral health, substance use, or social needs, including barriers to education, financial stability, and others.
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Face barriers to getting care in another setting.
A program intended for multi-visit patients.
We launched our Emergency Department Multi-Visit Patient (ED MVP) program at one MedStar Health hospital in 2021. Informal analysis showed it was helping, so we soon expanded it to four hospitals in the MedStar Health system.
In addition to changing our language to reduce stigma by identifying these patients as “MVPs” instead of “frequent flyers”, the program has a few critical steps:
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Providers conduct a comprehensive review of the patient’s medical records
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An interdisciplinary team including doctors, nurses, social workers, community health workers, and other clinicians develops a personalized care plan for that patient to reduce barriers to care, address unmet social needs, and promote access to outpatient care.
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The team activates the plan with resources dedicated to the ED MVP program.
To learn if programs like ED MVP are effective, comparing how often a patient comes in before and after participation is tempting. While this can give us a sense of our impact, this measurement can be deceptive.
Related reading: Research: Loneliness and Social Network Impact Mental Health Well Being.
Designing a study to understand the impact.
“Regression to the mean” can make things murky when analyzing programs like ED MVP. For example, a patient recently diagnosed with diabetes may come into the ED often. Poorly controlled blood sugar can cause complications such as foot infections or nerve damage. We can treat these patients’ immediate concerns in the ED, and often they connect with a primary care provider (PCP) to manage their diabetes and reduce ED visits.
But did our program help, or did the patient visit less often because we provided medical care?
To understand the true impact of ED MVP, we partnered with our colleagues in MedStar Health Research Institute’s Health Economics and Aging Research (H.E.A.R.) Institute. Together, we designed a study using a difference-in-differences (DiD) approach to compare two groups: One that got care through the program and one that did not. Known as a quasi-experimental design, DiD enables us to understand the effects of ED MVP more fully and be sure that our results are not due to things like regression to the mean.
When we compared outcomes for the two groups, the results were clear: Our program reduces ED visits, overnight stays, and hospital admissions by two days per patient on average. There was also a small but significant impact on inpatient readmissions when patients returned for care after being hospitalized.
Related reading: Research Explores How Clinics Understand and Address Social Risk Factors Among Women of Reproductive Age and Young Children.
Working together for everyone’s health.
This study puts to rest the idea that people who often come to the ED can’t be helped. Instead, patients and the health system can benefit from an intentional, coordinated effort to address their unmet needs.
By taking this personalized approach to health, we can have a much greater impact on our patients than we could by focusing only on their medical needs. That often means connecting them with community organizations that offer housing programs, mental health clinics, and other services.
Now that we know programs like ED MVP can advance health, we can work at a policy level to craft financial incentives to sustain these programs. Reducing frequent visits to the ED can be one step toward lowering costs and making healthcare more efficient. What’s more, programs like ED MVP can help patients, once seen as “unreachable,” improve their health and allow them to spend more time enjoying a healthier life.
