Patients’ Use of Multiple Acute Care Facilities

Timely access to patients’ health information is a key component in delivering effective and safe medical treatment, but pertinent clinical information is often difficult to obtain, particularly in acute care settings, where the urgency for decision-making does not permit time to track down health history. Fragmentation of medical information puts patients at risk for medical errors, duplication of tests, adverse events, and unnecessary healthcare costs. Researchers recently conducted a retrospective observational study to quantify the burden of fragmentation in acute healthcare facilities in Massachusetts by measuring the rates at which patients seek care across multiple sites. They reported study results in Archives of Internal Medicine [2010;170(22):1989-1995].

The study utilized data from the databases compiled by the Division of Healthcare Finance and Policy in Massachusetts (Outpatient Hospital Emergency Database, the Outpatient Observation Database, and the Inpatient Hospital Discharge Database). The databases included information on all adult acute care visits and admissions to emergency departments, inpatient units, and observation units from October 1, 2002, to September 30, 2007, at the 77 nonfederal acute care hospitals and satellite emergency facilities in the state. The primary outcome variable was the use of >1 acute care site by a patient with at least 2 acute care visits during the study period. Multisite users were defined as patients who visited or were hospitalized at ≥2 sites of care; patients who visited only 1 site of care were considered same-site users.

There were 3,692,178 adults who visited an acute care facility during the study period, representing 12,758,498 acute care visits. Of those, 1,130,124 adult patients visited ≥2 hospitals in Massachusetts for care. These multisite users accounted for 56.5% of all acute care visits during the study period. Mean age of the multisite users was 47.4 years, 53.6% were female, and 72.2% identified themselves as white. Mean number of visits to the ED at any hospital was 3; median number of hospitalizations was 2. The median number of distinct hospitals used by an individual patient for ED visits was 2. Mean cost for the ED visit was $1128; mean total hospitalization costs were $12,050. A subgroup of patients visited ≥5 different acute care sites during the study period (n=43,794). Patients in this subgroup, identified as high-intensity multisite users, represented 8.2% (n=1,040,105) of all adult patient visits and hospitalizations to acute care facilities. Compared to same-site users, multisite users were younger (P<.001), more likely to be male (P<.001), and more likely to have a primary psychiatric diagnosis (P<.001). They were also hospitalized more frequently (P<.001) and incurred more charges (P<.001). Mean length of stay was slightly shorter for multisite users compared with same-site users.

In an adjusted comparison, the high-intensity multisite users were compared with same-site users with similar patterns of use of acute care facilities, with similar results: high-intensity multisite users were more likely to be male, were younger, and were more likely to have a primary psychiatric diagnosis at any 1 acute care visit. Patients in this subgroup also were more likely to be hospitalized and have a longer mean length of stay per hospitalization. Mean per patient ED charges and hospitalization charges were significantly higher for the high-intensity multisite users compared with the same-site users (P<.001). According to the researchers, this study is the first to quantify at the population level the degree to which patients seek care at multiple sites, noting that during the study period one third of all adults presenting to an acute care hospital in Massachusetts visited ≥2 sites, accounting for >50% of all acute care visits. In conclusion, the researchers commented that the findings “provide one basis for assessing the value of an integrated electronic health information system for clinicians caring for patients across sites of care and therefore the return on investment in health information technology.”