Frequent Emergency Room Visitors Associated with a Pain-Discharge Diagnosis

Introduction: Emergency Departments (EDs) have experienced an increase in annual patient visits and length of stay over the past decade. Management of frequent user patients with pain-related diagnoses are challenging in a time-limited setting. Methods: This was a retrospective longitudinal cohort study of hospital ED visits from two EDs in San Diego County using encounters from September 2016 to August 2018. Frequent users were characterized as having 4 or more visits in a one-year period. Frequent users were further classified by the number of pain visits in a 12-month period into three categories: Non-pain frequent users, occasional frequent pain users and frequent pain users. Descriptive, univariate and regression analyses are reported for all demographic and clinical characteristics for index encounters, patient level data and pain subgroups. Results: Of all patients, 11.3% (n=5,174) were identified as frequent users, accounting for 38.9% (n=91,114) of all ED visits. Of all frequent ED users, 5.0% (n=259) had four or more primary pain visits in 12-month period; and, 34.2 % (n=1,770) had one to three primary pain visits. Overall, frequent pain users were more likely to be of middle age (OR=1.70, 95% CI = 0.80, 1.72), female (OR=2.43, 95% CI=1.79, 3.29), Non-Hispanic white (OR=1.11, 95% CI=0.83,1.50), have commercial insurance (OR=1.91, 95% CI= 1.37, 2.66) and have 10 or more ED encounters in a 12-month period (OR=23.66, 95% CI=17.12, 32.71). Conclusion: In this study, independent associations between occasional and frequent pain users were found among demographic and clinical characteristics such as being female, being of commercial payer status and having 10 or more ED visits in a year. Understanding characteristics of ED frequent users with pain related diagnoses may inform community-based interventions designed to reduce episodic care and thereby improve care coordination and management.