Operationalizing Frequent Emergency Department Use: A Systemic Perspective

Frequent emergency department (ED) use has been the topic of much conversation, research, and debate in recent years as the healthcare sector in the U.S. makes the transition from volume- to value-based care. Although there are systemic factors associated with frequent ED use, this phenomenon is operationalized in research and media solely by the number of visits a patient makes to the ED. This linear, unidimensional way of framing the problem leads to interventions and policies that focus on reducing the number of ED visits, while ignoring value-based measures of care such as health outcomes or whether patients are receiving appropriate kinds of care. This dissertation includes six chapters, comprising (a) an introduction to the dissertation, (b) a literature review examining the way in which frequent ED use is defined, and informs research, interventions, media, and policy, (c) a systematic review of research that defines frequent ED use, (d) a chapter outlining the methodology for the empirical research study, (e) an empirical research study using machine learning algorithms to develop ED patient cohorts or clusters based on systemic data, and finally (f) a policy brief in which recommendations are made based on the empirical findings of the original research from this dissertation