Medical and social characteristics of super-utilizers: A case-control study of patients frequently admitted to a Southern public hospital. Público

Abstract

Introduction: Super utilizers of healthcare services are defined as individuals who are high cost, frequent users of health services. These individuals make up a highly complex patient population that represents the intersection of public health policy, social determinants of health, rising healthcare costs, and clinical prevention and treatment. This research aims to describe characteristics of the patient population at Grady Hospital that qualifies as super-utilizers of Grady's inpatient services. It also aims to provide an epidemiological model that explains which patient characteristics are independently associated with higher odds of becoming a super-utilizer.

Methods: We conducted a case-control study of high utilizer patients at a public hospital in Atlanta, Georgia. Cases were defined as patients with three or more inpatient admissions in a calendar year; age- and sex-matched controls had one or two admissions in a calendar year. Data was collected via retrospective chart review. Logistic regression models were developed to determine patient factors that contribute to higher odds of high utilizer patient (HUP) status. A second logistic regression pooling cases and controls was conducted to determine if HUP status independently contributed to increased mortality.

Results: Patient factors contributing to high utilization of inpatient services included both clinical and non-clinical characteristics. Adjusted for socio-demographic, clinical, and social factors, Medicaid beneficiaries were five times more likely to be high utilizer compared to controls (OR 5.217, 95% CI 1.902, 14.305). History of substance use and homelessness were also significantly associated with HUP status (OR 2.641, 95% CI 1.268, 5.501; OR 2.906, 95% CI 1.122, 7.530, respectively). Clinical conditions contributed between nearly two and nearly six times higher odds of being a high utilizer patient. HUP status was also found to contribute to higher mortality, with high utilizer patients having more than twice the odds of dying compared to non-high utilizer patients, despite all other factors being considered.

Discussion: The high utilizer patient population at Grady has not only significant medical comorbidities, but also clear social barriers that result in high health services utilization. Coordinated care interventions can address both issues and have the potential to improve patient health while decreasing costs.

Table of Contents

I. INTRODUCTION 1

Problem Statement 2

Purpose Statement 3

Significance Statement 3

II. FORMAL REVIEW OF THE LITERATURE 4

Dimensions of Healthcare Costs 4

Andersen Healthcare Utilization Framework 7

Super-Utilizers: Complex Needs and Preventable Use of Healthcare Services 10

The Grady Context 12

III. METHODS 14

Study Design 14

Data Source 14

Study Population 15

Data Collection 16

Analysis 20

IV. RESULTS 22

V. DISCUSSION 27

High Utilizer Patient Characteristics 27

Factors Associated with High Utilization of Grady's Inpatient Services 29

Factors Associated with Mortality Among Patients of Grady's Inpatient Services 30

Andersen Framework and Consistency with Other Literature 31

Study Strengths and Limitations 33

Opportunities for Future Research 36

Coordinated Care Interventions in Practice 37

Concluding Remarks 39

VI. WORKS CITED 41

VII. TABLES AND FIGURES 44

Table 1. Patient social and demographic characteristics 45

Table 2. Patient diagnoses by disease category and organ system 46

Table 3. Health care utilization (ED visits, number of admissions, outpatient medications, length of stay, time to readmission, disposition) and mortality in cases and controls 47

Table 4. Demographic, social, and medical contributions to high utilization of inpatient services at Grady Hospital 48

Table 5. Demographic, social, and medical contributors mortality of individuals admitted to inpatient services at Grady Hospital 50

VIII. APPENDICES 52

Appendix A. Chart Abstraction Protocol 52

Appendix B. Classification of patient diagnoses by organ system/disease category 54

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Health Care Management
Palabra Clave	health services research super-utilizers
Committee Chair / Thesis Advisor	Ali, Mohammed K, Emory University
Partnering Agencies	Emory University schools, faculty or affiliated programs Hospital or other health care provider

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