High users don’t always stay high users (again)

OK, so maybe this is labouring the point as we’ve gone on about this out before – e.g. see our previous papers on the subject (here and here). Nevertheless, it’s nice to find that someone else agrees.

This time it’s a study from the US. They call their frequent flyers ‘super-utilizers’ but it’s the same idea – people who have multiple visits to the emergency department and frequent hospital admissions. The study was from Colorado and they found that 3% of their population were responsible for 30% of the hospital costs. But when they looked at these super-utilizers a year later, only just over a quarter were still high users. The rest had just had a bad year.

Some of their results are peculiarly American. They were studying Denver Health, which is a so-called safety net hospital which receives a high proportion of patients who are uninsured or on benefits. One of their categories of A&E attendance was for emergency renal dialysis which I interpret as people who simply haven’t got a routine source of care for their renal failure. Another major category was admissions for trauma (road accidents, violence in the community).

So these results can’t translate directly to the UK. But the message is the same, and correct for us too. Predicting hospital use is a tricky business and focusing on very high users (e.g. as in current NHS policy, such as the DES which incentivises GPs to find their top 2% of patients at risk of admission) isn’t going to be very effective. Anyhow, we have a paper in press putting some figures on just how unlikely current policies are to work, so I’ll blog about that when it comes out.


  1. Roland M, Dusheiko M, Gravelle H, Parker S. Follow up of people aged 65 and over with a history of emergency admissions: analysis of routine admission data. British Medical Journal 2005; 330: 289
  2.  Roland M, Abel G. Reducing emergency admissions: are we on the right track? BMJ 2012; 345: e6017
  3. Johnson T et al. For many patients who use large amounts of health care services, the need is intense but temporary. Health Affairs 2015; 34: 1312


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