System-Wide Patterns of Costs and Service Use Among Frequent Emergency Department Users in the United Kingdom

Objectives We estimate healthcare costs and service utilization for frequent users (FUs) of emergency departments (EDs) compared with non-FUs across the urgent care pathway, using regional UK data. Recognizing FU heterogeneity and differences in service models, we examine cost variation by patient characteristics and across healthcare providers. Methods Data were obtained from the Centre for Urgent and Emergency Care Research database, linking ED, emergency inpatient, ambulance, and National Health Service 111 data in Yorkshire and the Humber. FUs were defined as patients with 85 ED attendances over the 12-month period from April 2016 to March 2017. Multilevel generalized linear regression, adjusting for demographics, deprivation, psychosocial problems, multimorbidity, and acuity, estimated annual costs and utilization, with random effects by hospital trust. Earlier years (2014/2015-2015/2016) were examined in sensitivity analyses. Results FUs accounted for 2.8% of patients but 14.8% of total costs. Model-adjusted annual ED attendances were 9.1 for FUs versus 2.2 for non-FUs. Adjusted annual per-patient costs (3 154 764 FUs; 32 772 non-FUs) were driven largely by inpatient admissions. FUs also had higher ambulance and National Health Service 111 use. Among FUs, psychosocial issues were associated with more ED and pre-hospital use, whilst older patients with multi-morbidity were more likely to require admission. FU costs varied across providers, with lower-than-average costs in one trust operating a community-based FU service. Conclusion FUs generate disproportionately high costs across the urgent and emergency care network. Tailored interventions and coordinated emergency, primary, and community care may help address complex needs, reduce avoidable ED admissions, and improve patient outcomes.