Problem: Superutilizers use significant healthcare resources and face several socioeconomic challenges. Prior interventions solely focusing on care coordination have not sufficed for complex patients or in decreasing utilization or costs. This study aims to identify specific challenges areas faced by Maryland superutilizers to help drive resource allocation and targeted interventions.
Measurement: We measured ED utilization using visit counts in a 12-month period. Superutilizers are patients with 6+ documented ED visits. A Pareto chart measured areas for opportunity. Upon mapping superutilizers to their corresponding practice, key informant interviews and focus groups were conducted. A fishbone diagram was constructed for root cause analysis.
Analysis: This study was a retrospective review of health claims to identify Medicare FFS patients attributed to Maryland with 6+ ED visits (10/01/2020 – 09/30/2021). Principal diagnoses using HCUP multi-level Clinical Classification Software (CCS) definitions were stratified by frequent (6-16) and highly frequent (17+) to identify improvement areas.
Implementation: Bespoke practice QI interventions will be implemented target specific practices. Obstacles will include provider engagement and low prioritization of QI interventions due to the pandemic and clinician burnout. The benefit to healthcare quality professionals lies in lessons learned from this “pilot,” like designing QI initiatives and applying lessons about scalability and sustainability.
Results/Discussion: Superutilizers in this population have risk factors making them more susceptible to greater ED use, most prevalent in mental health. Superutilizers tended to visit the ED for circulatory system diseases and “Symptoms, signs; and ill-defined conditions that influence health status” (CCS). Results will be sustained using the IHI Scale-up Framework.