Original Research
Monday, October 14, 2024
01:00 PM–02:30 PM
Abstract
Introduction:
Patients characterized as "super utilizers" account for a higher rate of acute care utilization than the general population and often have multiple chronic conditions, complex medication regimens, and unfavorable social determinants of health. Patient characteristics that predispose to healthcare super-utilization have not been well-defined.
Research Question or Hypothesis:
What patient-specific factors are associated with healthcare super-utilization following hospital discharge?
Study Design:
A retrospective cohort study of primary care patients from multiple primary care practices in Western New York discharged from the hospital between 2019-2022. Primary care practices were a mix of urban and suburban practice sites.
Methods:
Healthcare super-utilization was defined as five or more emergency department visits or readmissions within one year following the index hospital discharge. Variables were analyzed using a multivariable logistic regression model. Covariates with a p-value <0.25 in bivariate analysis were considered candidates for inclusion in the final model. Variables were removed in a backwards stepwise manner based on significance. A 2-sided a value <0.05 was considered statistically significant.
Results:
A total of 392 patients were included in the analysis, with 57 (17%) identified as healthcare super-utilizers in the year following index discharge. Black patients had a higher risk of increased healthcare utilization compared to White patients (OR 2.4, 95% CI 1.2-4.9, p=0.02) while females had a decreased risk compared to males (OR 0.5, 95% CI 0.26-0.95, p=0.0341). Patients with a high HOSPITAL score, which has been shown predictive of readmission risk, had a higher risk of increased healthcare utilization compared to those with a low HOSPITAL score (OR 6.9, 95% CI 2.77-17.05, p<0.0001).
Conclusion:
Male gender, Black race, and high HOSPITAL readmission score were predictive of increased healthcare utilization. Further analysis is required to determine how other factors, such as social determinants of health, impact healthcare super-utilization and what interventions can be designed to target patients at highest risk.
Presenting Author
Collin M. Clark PharmD, BCPS, BCGPUniversity at Buffalo Jacobs School of Medicine and Biomedical Sciences
Authors
Courtney Cardinal PharmD, BCACP, BCPS, CDCES
Great Lakes Integrated Network/General Physician, PC
David M. Jacobs PharmD, PhD
University at Buffalo School of Pharmacy and Pharmaceutical Sciences
Erin M. Slazak Pharm.D., BCPS, BCACP
University at Buffalo School of Pharmacy and Pharmaceutical Sciences