Frequent Emergency Department Research Articles

Enhanced home palliative care could reduce emergency department visits due to non-organic dyspnea among cancer patients: a retrospective cohort study

BackgroundDyspnea is a common trigger of emergency department visits among terminally ill and cancer patients. Frequent emergency department (ED) visits at the end of life are an indicator of poor-quality care. We examined emergency department visit rates due to dyspnea symptoms among palliative patients under enhanced home palliative care.MethodsOur home palliative care team is responsible for patient management by palliative care specialists, residents, home care nurses, social workers, and chaplains. We enhanced home palliative care visits from 5 days a week to 7 days a week, corresponding to one to two extra visits per week based on patient needs, to develop team-based medical services and formulate standard operating procedures for dyspnea care.ResultsOur team cared for a total of 762 patients who exhibited 512 ED visits, 178 of which were due to dyspnea (mean ± SD age, 70.4 ± 13.0 years; 49.4% male). Dyspnea (27.8%) was the most common reason recorded for ED visits, followed by pain (19.0%), GI symptoms (15.7%), and fever (15.3%). The analysis of Group A versus Group B revealed that the proportion of nonfamily workers (42.9% vs. 19.4%) and family members (57.1% vs. 80.6%) acting as caregivers differed significantly (P < 0.05). Compared to the ED visits of the Group A, the risk was decreased by 30.7% in the Group B (P < 0.05).ConclusionsThis study proves that enhanced home palliative care with two additional days per week and formulated standard operating procedures for dyspnea could significantly reduce the rate of ED visits due to non-organic dyspnea during the last 6 months of life.

Emergency Department Utilization by Adolescents Experiencing Homelessness in Massachusetts.

Adolescents who experience homelessness rely heavily on emergency departments (EDs) for their health care. This study estimates the relationship between homelessness and ED use and identifies the sociodemographic, clinical, visit-level, and contextual factors associated with multiple ED visits among adolescents experiencing homelessness in Massachusetts. We used the Healthcare Cost and Utilization Project State Emergency Department Databases on all outpatient ED visits in Massachusetts from 2011 to 2016. We included all adolescents who were 11-21 years old. We estimated the association between homelessness and ED utilization and investigated predictors of multiple ED visits among adolescents who experience homelessness using multivariate logistic and negative binomial regressions. Our study included 1,196,036 adolescents, of whom about 0.8% experienced homelessness and this subset of adolescents accounted for 2.2% of all ED visits. Compared with those with stable housing, adolescents who were homeless were mostly covered through Medicaid (P<0.001), diagnosed with 1 or more comorbidities (P<0.001), and visited the ED at least once for reasons related to mental health; substance and alcohol use; pregnancy; respiratory distress; urinary and sexually transmitted infections; and skin and subcutaneous tissue diseases (P<0.001). Homeless experience was associated with multiple ED visits (incidence rate ratio=1.18; 95% confidence intervals, 1.16-1.19) and frequent ED use (4 or more ED visits) (adjusted odds ratio=2.21; 95% confidence interval, 2.06-2.37). Factors related to clinical complexity and Medicaid compared with lack of coverage were also significant predictors of elevated ED utilization within the cohort experiencing homelessness. Adolescents who experience homelessness exhibit higher ED use compared with those with stable housing, particularly those with aggravated comorbidities and chronic conditions. Health policy interventions to integrate health care, housing, and social services are essential to transition adolescents experiencing homelessness to more appropriate community-based care.

Impact of emergency department length of stay on anxiety and comfort in older people

IntroductionOlder people are frequent emergency department (ED) users, a vulnerable population and often have long stays in the ED. The aim of this study was to determine whether ED length of stay (LOS) had an impact on older people’s (aged ≥65 years) anxiety, comfort and adverse events. MethodsThis prospective observational study was conducted in Melbourne, Australia. Patients (n = 301) from three EDs were classified by ED LOS: ≤4-hours (n = 89), 4–8 h (n = 136) and >8-hours (n = 76). Current state and trait anxiety and comfort were measured in ED. Adverse event data were collected from medical records. LOS groups were compared using Chi-Square and Kruskal-Wallis test. ResultsThere was no significant difference in Trait Anxiety Scores. Patients with ED LOS ≤ 4-hours had lower median State Anxiety Scores (p = 0.003), were less likely to require ward admission (p < 0.001), and more likely to require short stay unit admission (p < 0.001). There were no significant differences between groups in comfort or adverse events during ED care or hospitalisation (for admitted patients). ConclusionThe impact of ED LOS on the anxiety of older ED users appears limited. There was no association identified between ED LOS and comfort during ED care or adverse events during ED care or hospitalisation.

"I wanted to participate in my own care": Evaluation of a Patient Navigation Program.

IntroductionPatient navigation programs can help people overcome barriers to outpatient care. Patient experiences with these programs are not well understood. The goal of this study was to understand patient experiences and satisfaction with an emergency department (ED)-initiated patient navigation (ED-PN) intervention for US Medicaid-enrolled frequent ED users.MethodsWe conducted a mixed-methods evaluation of patient experiences and satisfaction with an ED-PN program for patients who visited the ED more than four times in the prior year. Participants were Medicaid-enrolled, English- or Spanish-speaking, New Haven-CT residents over the age of 18. Pre-post ED-PN intervention surveys and post-ED-PN individual interviews were conducted. We analyzed baseline and follow-up survey responses as proportions of total responses. Interviews were coded by multiple readers, and interview themes were identified by consensus.ResultsA total of 49 participants received ED-PN. Of those, 80% (39/49) completed the post-intervention survey. After receiving ED-PN, participants reported high satisfaction, fewer barriers to medical care, and increased confidence in their ability to coordinate and manage their medical care. Interviews were conducted until thematic saturation was reached. Four main themes emerged from 11 interviews: 1) PNs were perceived as effective navigators and advocates; 2) health-related social needs were frequent drivers of and barriers to healthcare; 3) primary care utilization depended on clinic accessibility and quality of relationships with providers and staff; and 4) the ED was viewed as providing convenient, comprehensive care for urgent needs.ConclusionsMedicaid-enrolled frequent ED users receiving ED-PN had high satisfaction and reported improved ability to manage their health conditions.

Emergency department frequent user subgroups: Development of an empirical, theory-grounded definition using population health data and machine learning.

Frequent emergency department (ED) use has been operationalized in research, clinical practice, and policy as number of visits to the ED, despite the fact that this definition lacks empirical evidence and theoretical foundation. To date, there are no studies that have attempted to understand ED use empirically, without arbitrary use of "cut-points." This study was conducted to identify the best-performing, empirically grounded definition of frequent ED use. The performance of machine learning supervised clustering algorithms based on the most common definitions of frequent ED use in peer-reviewed literature (i.e., 3+, 4+, 5+ visits per year) were compared to unsupervised clustering algorithms that take into account numerous systemic factors associated with patients' ED use. All ED visits for the State of Florida, 2011-2015, including more than 100 clinical and payment-related variables per visit were employed in the model. Supervised algorithms using number of visits to the ED, alone, were unable to differentiate patients into clusters, while unsupervised models using all patient data formed clusters in which patients within a given cluster were alike, and patients between clusters were different. Cluster size and characteristics were stable across years. The results of this study indicate that mean number of ED visits by patients differ between patient clusters, but this does not allow for accurate identification of ED patients. Machine learning algorithms using all systemic and biopsychosocial patient data can be used to identify and group patients for the purpose of developing and testing integrated, whole health interventions. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Impact of mental illness on end-of-life emergency department use in elderly patients with gastrointestinal malignancies.

BackgroundElderly patients with gastrointestinal cancer and mental illness have significant comorbidities that can impact the quality of their care. We investigated the relationship between mental illness and frequent emergency department (ED) use in the last month of life, an indicator for poor end‐of‐life care quality, among elderly patients with gastrointestinal cancers.MethodsWe used SEER‐Medicare data to identify decedents with gastrointestinal cancers who were diagnosed between 2004 and 2013 and were at least 66 years old at time of diagnosis (median age: 80 years, range: 66–117 years). We evaluated the association between having a diagnosis of depression, bipolar disorders, psychotic disorders, anxiety, dementia, and/or substance use disorders and ED use in the last 30 days of life using logistic regression models.ResultsOf 160,367 patients included, 54,661 (34.1%) had a mental illness diagnosis between one year prior to cancer diagnosis and death. Patients with mental illness were more likely to have > 1 ED visit in the last 30 days of life (15.6% vs. 13.3%, p < 0.01). ED use was highest among patients with substance use (17.7%), bipolar (16.5%), and anxiety disorders (16.4%). Patients with mental illness who were male, younger, non‐white, residing in lower income areas, and with higher comorbidity were more likely to have multiple end‐of‐life ED visits. Patients who received outpatient treatment from a mental health professional were less likely to have multiple end‐of‐life ED visits (adjusted odds ratio 0.82, 95% confidence interval 0.78–0.87).ConclusionsIn elderly patients with gastrointestinal cancers, mental illness is associated with having multiple end‐of‐life ED visits. Increasing access to mental health services may improve quality of end‐of‐life care in this vulnerable population.

Characteristics of sickle cell patients with frequent emergency department visits and hospitalizations

Vaso-occlusive episodes (VOEs) are a hallmark of sickle cell disease (SCD), and account for >90% of health care encounters for this patient population. The Cooperative Study of Sickle Cell Disease, a large study enrolling >3000 patients, showed that the majority of SCD patients (80%) experienced 0-3 major pain crises/year. Only a small minority (~5%) experienced ≥6 VOEs/year. Our study sought to further understand this difference in VOE frequency between SCD patients. We analyzed 25 patients (13M/12F, mean age of 28.8) with ≥6 ED visits or hospitalizations/year (high utilizers), and compared these with 9 patients (6M/3F, mean age of 37.6) who had ≤2 ED visits or hospitalizations/year (low utilizers). All subjects were given a demographic survey along with questionnaires for depression, anxiety, and Health Locus of Control. Each subject then underwent quantitative sensory testing (QST) with three different modalities: pressure pain sensitivity, heat and cold sensitivity, and Von Frey monofilament testing. Laboratory and clinical data were collected through subjects' medical records. CBC and chemistry analysis showed high utilizers had higher WBC (p<0.01), ANC (p<0.01), total bilirubin (p = 0.02), and lower MCV (p = 0.03). Opioid use (morphine equivalents) over the past 6 months was significantly higher in the high utilizer group (12125.7 mg vs 2423.1 mg, p = 0.005). QST results showed lower pressure pain threshold at the ulna (224.4 KPa vs 338.9 KPa, p = 0.04) in the high utilizer group. High utilizers also had higher anxiety (9.0 vs 4.6, p = 0.04) and depression scores (10.0 vs 6.0, p = 0.051). While the low utilizer group had higher education levels with more associate and bachelor degrees (p = 0.009), there was no difference in income or employment. These data show that many biological and psychosocial factors contribute to high health care utilization in SCD. A multi-disciplinary and multi-faceted approach will be required to address this complex problem.

Examining frequent emergency department use among children and adolescents with autism spectrum disorder.

This study used data for 5.9 million individuals with 9.1 million emergency department visits from all hospitals in the state of New York to explore frequent emergency department use between children and adolescents with autism spectrum disorders and those without autism spectrum disorders. We found that children and adolescents with autism spectrum disorders had larger shares of comorbidities and diagnoses related to attention-deficit/hyperactivity disorder, intellectual disability, and epilepsy. Children and adolescents with autism spectrum disorders were also more likely to utilize emergency departments and to exhibit frequent use. These results emphasize the need for using family-centered care to improve the care experiences of children and youth with autism spectrum disorders and their families. In addition, the education of emergency department staff of processes and practices as it relates to delivery of care and the care experience.

Identifying medication-related problems in pharmacist-run home visits

BackgroundHome visits (HVs) may be warranted for many reasons (e.g., uncontrolled disease states, suspected psychosocial issues, frequent hospitalizations, poor health literacy). Patients who frequently visit the emergency department (ED) are high-risk individuals, oftentimes exhibiting health-related barriers and medication-related problems (MRPs). ObjectivesThis study seeks to answer whether HVs for frequent ED users conducted by a pharmacist with pharmacy students will detect more MRPs compared to office visits (OVs) and enhance patient perception of HV services. MethodsPatients who visited the ED at least twice over a 12-month period were included in a retrospective chart review. Eligible patients were randomized into an HV group or OV group. Patients in the HV group were visited by a pharmacist and pharmacy students to identify and resolve MRPs, whereas patients in the OV arm brought their medications into the office for review. Patients in the HV group completed a pre- and postvisit survey about their experiences. ResultsEighteen patients participated in the study: 10 patients were randomized to the OV arm and 8 patients were randomized to the HV arm. A total of 39 MRPs were identified in 8 HVs versus 33 MRPs in 10 OVs (mean 5 ± 0.926 vs. 3.3 ± 1.89, P = 0.034). Overall, nonadherence was the most common MRP and medication reconciliation was the most common intervention. All 8 HV patients completed the pre- and post-HV surveys. Post-HV survey results indicated that patients agreed that student pharmacists were professional team members and that their HV was needed. The patients agreed to recommend a pharmacist-run HV. ConclusionPatient homes serve as alternative and convenient spaces for pharmacists to help manage their medications, specifically to identify MRPs and provide meaningful recommendations.

MANAGEMENT OF ACUTE ABDOMINAL PAIN

Background: Acute abdominal pain (AAP) is one of the most common causes of referral to an emergency department (ED), but information about its impact is limited.&#x0D; Objectives: The objectives of this article are to define the prevalence of AAP among ED visits in a large university hospital and analyze its main clinical features.&#x0D; Methods: All patients admitted at the Sant’ Orsola, Malpighi University Hospital of Bologna ED on 12?a priori selected sample days in 2013 were included. General data were recorded for each patient. A total of 192 clinical variables were recorded for each patient with abdominal pain.&#x0D; Results: During the observation period the ED assisted 2623 patients with a daily admission rate of 219?±?20 (mean?±?SD). Of these, 239 patients complained of AAP as their chief complaint at entry (prevalence?=?9.1%). AAP prevalence was significantly higher in females than in males (10.4% vs. 7.8%; OR?=?1.37; p?=?0.021) as well as in foreign over Italian patients (13.2% vs. 8.5%; OR?=?1.64; p?=?0.007). The most frequent ED operative diagnoses were non-specific abdominal pain (n?=?86, 36.0%) and gastrointestinal (GI) tract-related pain (n?=?79, 33.1%; n?=?19 upper GI, n?=?60 lower GI).&#x0D; Conclusions: AAP is a common cause of referral at EDs. Despite technological advances, non-specific abdominal pain is still the main operative diagnosis.&#x0D; Keywords: Acute, Abdominal, Pain, Management

Social support and healthcare utilization of caregivers of Latinas with breast cancer.

Family caregivers experience significant health consequences related to caregiving, including higher mortality rates. Latino caregivers may have additional challenges related to social determinants of health. Gender and social support are key factors to consider in the context of chronic illnesses and healthcare use in caregivers of Latinos diagnosed with cancer. The purpose of this study was to examine the moderating effect of gender and social support on the relationship between chronic illnesses and healthcare utilization in caregivers of Latina breast cancer survivors. This was a secondary analysis of family caregivers from an experimental study with breast cancer survivors and their designated family caregivers. Participants completed telephone surveys about demographics, presence of chronic illnesses, frequency of emergency department, urgent care, and hospital visits, social support, and acculturation. Data were analyzed for direct and moderated relationships. There was a significant relationship between number of chronic illnesses and healthcare utilization, informational support, and social isolation. Income and acculturation were not related to chronic illnesses or healthcare utilization. Gender did not moderate the relationship between chronic illnesses and healthcare utilization. Informational support was a marginal moderator of the relationship between chronic illnesses and healthcare utilization alone and with acculturation and income included as covariates. Clinicians should consider the influence of informational support and social isolation on chronic illnesses and healthcare use in caregivers of Latina breast cancer survivors, specifically, how these factors may influence navigation of the healthcare system.

Health care providers\u2019 perception of the frequent emergency department user issue and of targeted case management interventions: a cross-sectional national survey in Switzerland

BackgroundFrequent users of emergency departments (FUEDs) (≥5 ED visits/year) represent a vulnerable population with complex needs accounting for a significant number of emergency department (ED) consultations, thus contributing to EDs overcrowding. Research exploring ED staff perceptions of FUEDs is scarce.ObjectivesThe current study aimed to evaluate in ED staff a) the extent to which FUEDs are perceived as an issue; b) their perceived levels of knowledge and understanding of FUEDs; c) levels of perceived usefulness of case management (CM) and interest in implementing this intervention in their ED service.MethodsHead physicians of the EDs at all public hospitals in Switzerland (of various level of specialization) were sent a 19-item web-based survey, pilot tested prior to its dissemination. The head physicians were asked to forward the survey to ED staff members from different health professional backgrounds.ResultsThe hospital response rate was 81% (85/106). The exploitable hospital response rate was 71% (75/106 hospitals) including 208 responding health professionals. Issues and difficulties around FUEDs were perceived as important by 64% of respondents. The perceived frequency of being confronted with FUEDs was higher among nurses in more specialized EDs. In total, 64% of respondents felt poorly informed about FUEDs, nurses feeling less informed than physicians. The understanding of FUEDs was lower in the French-Italian-speaking parts (FISP) of Switzerland than in the German-speaking part. Eighty-one percent of respondents had no precise knowledge of FUED-related interventions. The perceived usefulness of CM interventions after receiving explanations about it was high (92%). However, the overall level of interest for CM implementation was 59%. The interest in CM by physicians was low across all regions and ED categories. Nurses, on the other hand, showed more interest, especially those in EDs of high specialization.ConclusionsThe majority of ED staff reported being confronted with FUEDs on a regular basis. Staff perceived FUEDs as a vulnerable population, yet, they felt poorly informed about how to manage the issue. The majority of ED staff thought a CM intervention would be useful for FUEDs, however there appears to be a gap in their desire or willingness to implement such interventions.

Identifying subgroups and risk among frequent emergency department users in British Columbia.

Objective: Frequent emergency department (ED) users are heterogeneous. We aimed to identify subgroups and assess their mortality. Methods: We identified patients ≥18 years with ≥1 ED visit in British Columbia from April 1, 2012 to March 31, 2015, and linked to hospitalization, physician billing, prescription, and mortality data. Frequent users were the top 10% of patients by ED visits.We employed cluster analysis to identify frequent user subgroups. We assessed 365‐day mortality using Kaplan‐Meier curves and conducted Cox regressions to assess mortality risk factors within subgroups. Results: We identified 4 subgroups. Subgroup 1 (“Elderly”) had median age 77 years (interquartile range [IQR]: 66–85), 5 visits/year (IQR: 4–6), median 8 prescription medications (IQR: 5–11), and 24.7% mortality. Subgroup 2 (“Mental Health and Alcohol Use”) had median age 48 years (IQR: 34–61), 13 visits/year (IQR: 10–16), and 12.3% mortality. They made a median 31 general practitioner visits (IQR: 19–51); however, only 23.7% received a majority of services from 1 primary care physician. Subgroup 3 (“Young Mental Health”) had median age 39 years (IQR: 28–51), 5 visits/year (IQR: 4–6), and 2.2% mortality. Subgroup 4 (“Short‐term”) had median age 50 years (IQR: 34–65), 4 visits/year (IQR: 4–5) regularly spaced over a short term, and 1.4% mortality. Male sex (all subgroups), long‐term care (“Mental Health and Alcohol Use;” “Young Mental Health”), and rural residence (“Elderly” in long‐term care; “Young Mental Health”) were associated with increased mortality. Conclusions: Our results identify frequent user subgroups with varying mortality. Future research should explore subgroups’ unmet needs and tailor interventions toward them.

An asthma plan

An asthma plan

Characteristics of frequent emergency department users in British Columbia, Canada: a retrospective analysis.

Background:Frequent emergency department users disproportionately account for rising health care costs. We aimed to characterize frequent emergency department users in British Columbia, Canada.Methods:We performed a retrospective analysis using health administrative databases. We included patients aged 18 years or more with at least 1 emergency department visit from 2012/13 to 2015/16, linked to hospital, physician billing, prescription and mortality data. We used annual emergency department visits made by the top 10% of patients to define frequent users (≥ 3 visits/year).Results:Over the study period, 13.8%–15.3% of patients seen in emergency departments were frequent users. We identified 205 136 frequent users among 1 196 353 emergency department visitors. Frequent users made 40.3% of total visits in 2015/16. From 2012/13 to 2015/16, their visit rates per 100 000 BC population showed a relative increase of 21.8%, versus 13.1% among all emergency department patients. Only 1.8% were frequent users in all study years. Mental illness accounted for 8.2% of visits among those less than 60 years of age, and circulatory or respiratory diagnoses for 13.3% of visits among those aged 60 or more. In 2015/16, frequent users were older and had lower household incomes than nonfrequent users; the sex distribution was similar. Frequent users had more prescriptions (median 9, interquartile range [IQR] 5–14 v. 1, IQR 1–3), primary care visits (median 15, IQR 9–27 v. 7, IQR 4–12) and hospital admissions (median 2, IQR 1–3 v. 1, IQR 1–1), and higher 1-year mortality (10.2% v. 3.5%) than nonfrequent users.Interpretation:Emergency department use by frequent users increased in BC between 2012/13 and 2015/16; these patients were heterogenous, had high mortality and rarely remained frequent users over multiple years. Our results suggest that interventions must account for heterogeneity and address triggers of frequent use episodes.

From Emergency Department Visit to Readmission After Esophagectomy: Analysis of Burden and Risk Factors

Frequent emergency department (ED) visits occur after esophagectomy. We aimed to identify the incidence of and risk factors for conversion from ED visit to inpatient admission. A retrospective cohort study was performed of consecutive esophagectomies at a tertiary Canadian center (1999 to 2014). Multivariable regression analyses identified factors associated with conversion from ED visit to admission. There were 520 esophagectomies with 6% inhospital mortality (n= 31). Of those discharged, 29.7% (n= 145) had one or more emergency visit and 43.4% (n= 63) of these patients were readmitted to the hospital. First-time ED visits resulted in inpatient conversion 23.4% of the time (n= 34); successive ED visits resulted in increasing conversion. On multivariable analysis, anastomotic leak (adjusted odds ratio 2.45; 95% confidence interval, 1 to 6.01; P= .05) was independently associated with higher odds of conversion to admission. Sensitivity analysis using Poisson regression to model conversion as a rate identified that living in regions further away was associated with lower conversion rate to admission (risk ratio 0.35; 95% confidence interval, 0.13 to 0.94; P= .04). Although postesophagectomy ED utilization is high, the majority of visits do not convert to admission. With each increasing ED visit, likelihood of converting to admission increases. Anastomotic leakage was associated with higher odds of conversion to admission, possibly related to development of strictures. Access to urgent outpatient endoscopy may help reduce the incidence of ED visits and admission. Although living in regions further away is associated with lower conversion rates to admission at the index hospital, that may be due to patients utilizing closer local hospitals.

Case management for frequent emergency department users: no longer a question of if but when, where and how.

Case management for frequent emergency department users: no longer a question of if but when, where and how.

Injuries and frequent use of emergency department services: a systematic review

ObjectiveTo review all studies having examined the association between patients with physical injuries and frequent emergency department (ED) attendance or return visits.DesignSystematic review.Data sourceMedline, Cumulative Index to Nursing and Allied...

Older Emergency Department Patients: Does Baseline Care Status Matter?

BackgroundLittle is known about the prognostic differences between older emergency department (ED) patients who present with different formal support requirements in the community. We set out to describe and compare the patient profiles and patterns of health service use among three older ED cohorts: home care clients, nursing home residents and those receiving no formal support.MethodsWe conducted a secondary analysis of the Canadian cohort from the interRAI multinational ED study. Data were collected using interRAI ED contact assessment on patients 75 years of age and older (n = 2,274), in eight ED sites across Canada. A series of descriptive statistics were reported. Adjusted associations were determined using logistic regression.ResultsOlder adults receiving no formal support services were most stable. However, they were most likely to be hospitalized. Older home care clients were most likely to report depressive symptoms and distressed caregivers. They also had the greatest odds of frequent ED visitation post-discharge (OR=1.9; 95% CI=1.39–2.59). Older adults transferred from a nursing home were the frailest but had the lowest odds of hospital admission (OR=0.14; 95% CI=0.09–0.23).ConclusionWe demonstrated the importance of inquiring about community-based formal support services and provide data to support decision-making in the ED.

Frequent User System Engagement: A Quality Improvement Project to Examine Outcomes of a Partnership to Improve the Health of Emergency Department Frequent Users.

Patterns of frequent emergency department (ED) use correlate with a variety of care needs. Health care systems should address these needs in collaboration with community health partners. Approximately 600 patients frequent a local ED for nonemergent needs. Approximately 15% of those patients are homeless. A program consistent with the Corporation for Supportive Housing's Frequent User System Engagement (FUSE) model was developed and implemented in a community setting. Eleven participants were enrolled in this pilot program. Eligible candidates enrolled in the program received coordinated multidisciplinary care and stable housing. ED visits, primary care provider visits, and number of diagnostic tests and costs changed significantly over time. The FUSE program is equipped to address the needs of the whole person, resulting in a meaningful impact on overall health while decreasing frequency of ED visits.