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Frequent emergency department (ED) users, colloquially known as “frequent fliers,” are a small population that account for a disproportionately large number of ED visits. Depending on the criteria used, ED super users may constitute as little as 1% of the individuals seen through the department, while accounting for up to 60% of the visit volume. There is an associated stress on the 911 system and a public health concern with burdening of already busy emergency departments. Unsurprisingly, ED super users have an associated financial cost. A 2015 Milwaukee area pilot program provided community outreach to only 39 of their well-known ED utilizers and still managed to return just over one million dollars in cost savings to the healthcare system. This patient population is frequently characterized by chronic illness including cancer, mental health disorders, substance use disorders, chronic kidney disease and chronic obstructive pulmonary disease (COPD).

At the University of Vermont Medical Center (UVMMC), a community outreach program is being assembled. Using both grant and internal funding, HealthNet paramedics and ED nurses will provide community-based care to the top 100 utilizers of the UVMMC Emergency Department. Methods include outreach to patients missing primary and subspecialty appointments, tracking pill counts, monitoring prescription refills, assessing medication adherence at home visits and assessing and addressing social determinants of health including housing and food stability. The program aims to decrease ED and EMS utilization, reduce health system costs and ultimately, improve patient outcomes. A similar program might be considered at CVPH, potentially utilizing CVPH Family Medicine staff for community outreach, as well as the clinic itself as a primary care alternative to frequent ED evaluation for chronic medical conditions.

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Community Health and Preventive Medicine | Health Services Research | Medical Education | Primary Care

Emergency Medicine Super Utilizers and the Role of Targeted Community Paramedicine