Abstract
BackgroundPatients with frequent hospital readmissions, or high-utilizer patients (HUPs), are a major driver of rising healthcare costs in the United States. This group has a significant burden of medical illness, but less is known about whether or how social determinants of health may drive their increased healthcare use and poor health outcomes. Our study aimed to define the population of HUPs at a large, safety-net hospital system, to understand how these patients differ from patients who are not HUPs, and to analyze how their demographic, medical, and social factors contribute to their healthcare use and mortality rates.MethodsFor this case-control study, data were collected via retrospective chart review. We included 247 patients admitted three or more times in a single calendar year between 2011 and 2013 and 247 controls with one or two admissions in a single calendar year matched for age, sex, and year of high-utilization. We used multivariable logistic regression models to understand which demographic, clinical, and social factors were associated with HUP status, and if HUP status was independently associated with mortality.ResultsThe factors that contributed significant odds of being a HUP included having Medicaid (OR 3.34, 95% CI 1.50, 7.44) or Medicare (OR 3.39, 95% CI 1.50, 7.67), having a history of recreational drug use (OR 2.44, 95% 1.36, 4.38), and being homeless (OR 3.73, 95% CI 1.69, 8.23) The mortality rate among HUPs was 22.6% compared to 8.9% among controls (p < 0.0001).ConclusionsThese data show that social factors are related to high-utilization in this population. Future efforts to understand and improve the health of this population need to incorporate non-clinical patient factors.
Highlights
Patients with frequent hospital readmissions, or high-utilizer patients (HUPs), are a major driver of rising healthcare costs in the United States
More than 33% of all HUPs were in the lowest income quartile, compared to only 22% of controls (p = 0.002)
High-utilizer patients had a higher prevalence of diseases in eleven out of thirteen disease categories, including cardiac, pulmonary, infectious, and psychiatric diseases
Summary
Patients with frequent hospital readmissions, or high-utilizer patients (HUPs), are a major driver of rising healthcare costs in the United States This group has a significant burden of medical illness, but less is known about whether or how social determinants of health may drive their increased healthcare use and poor health outcomes. High-utilizers have a high burden of chronic disease and mental illness [4, 8], often come from lower socioeconomic groups [9], and have limited access to primary and preventive care [10] They have higher rates of adverse social determinants of health, such as disability [11] social isolation [12], and food insecurity [7]. Despite their increased healthcare use, high-utilizers have poorer health outcomes and higher mortality rates than their peers [13, 14]
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