To optimize healthcare utilization, health outcomes, and costs, research is needed to improve an understanding of frequent users of emergency health services. Frequent use of emergency services is associated with high costs of healthcare and may be indicative of challenges accessing, or poor outcomes of, healthcare. We identified patient demographics and health factors related to frequent use of the emergency medical services (EMS) system of a mid-sized city. Study findings will aid in the development of targeted interventions to improve population health.
We reviewed 9-1-1 call dispatch data and Baltimore City Fire Department EMS records in 2008–10. Frequent use was defined as six or more EMS incidents in the 23 month period. Analyses used census data to compare demographics of EMS users to their population distribution; and examined differences in demographics and health problems of frequent EMS users compared to non-frequent users.
Frequent EMS users (n=1,969) had a range of 6–199 EMS incidents (mean 11.2) during the observation period; and though they accounted for only 1.5% of EMS users, they were involved in 12.0% of incidents. Frequent users, as compared to non-frequent users and to the population, were more likely to be male, African American, or 45 years or older. Of frequent users, the modal age group was 45–54 years, accounting for 29.7% of frequent users, which represented twice this age group’s population distribution. Furthermore, this age group had the greatest overrepresentation of males (63.0% of frequent users), and was the peak age group for substance abuse related incidents (28.0% of frequent users’ incidents in this age group). Frequent users compared to non-frequent users had lower levels of trauma related incidents (5.1% versus 16.7%) and higher levels of medical incidents (94.8% versus 82.9%). As proportions of EMS incidents among frequent versus non-frequent users, respiratory, mental health, and seizure related incidents were highest in the youngest age groups; and substance abuse related incidents were highest in those middle aged (35–44 years and 45–54 years). Of health problems, behavioral health (mental health or substance use) problems most contributed to frequent EMS use (23.4% of frequent users’ incidents). Across all incidents, 65.8% of frequent users had an indication of behavioral health problems, representing a 6.6-fold higher odds than non-frequent users (22.5%). Frequent compared to non-frequent users also had higher levels of select chronic conditions (diabetes: 39.9% vs. 14.6%, respectively; asthma: 40.9% vs. 13.4%; and HIV: 9.1% vs. 2.4%), with unadjusted odds almost 4 to 7 times higher.
The study findings revealed the major role of chronic somatic and behavioral health problems in frequent EMS use; and that rates of frequent use were highest among those middle aged, African American, and male. The results suggest the need for coordination of EMS with community-based, integrated medical and behavioral health services to improve access and utilization of preventive services, with implications for health outcomes and costs. The study demonstrates the value of EMS patient data in identifying at-risk populations and informing novel, targeted approaches to public health intervention.