Open Forum Infect Dis. 2020 Jan 31;7(2):ofaa037. doi: 10.1093/ofid/ofaa037. eCollection 2020 Feb.

High-Cost, High-Need Users of Acute Unscheduled HIV Care: A Cross-Sectional Study.

Open forum infectious diseases

Conor Grant, Colm Bergin, Sarah O'Connell, John Cotter, Clíona Ní Cheallaigh

PMID: 32110681 PMCID: PMC7041127 DOI: 10.1093/ofid/ofaa037

Abstract

BACKGROUND: High-cost, high-need users are defined as patients who accumulate large numbers of emergency department visits and hospital admissions that might have been prevented by relatively inexpensive early interventions and primary care. This phenomenon has not been previously described in HIV-infected individuals.

METHODS: We analyzed the health records of HIV-infected individuals using scheduled or unscheduled inpatient or outpatient health care in St James's Hospital, Dublin, Ireland, from October 2014 to October 2015.

RESULTS: Twenty-two of 2063 HIV-infected individuals had a cumulative length of stay >30 days in the study period. These individuals accrued 99 emergency department attendances and 1581 inpatient bed days, with a direct cost to the hospital of >€1 million during the study period. Eighteen of 22 had potentially preventable requirements for unscheduled care. Two of 18 had a late diagnosis of HIV. Sixteen of 18 had not been successfully engaged in outpatient HIV care and presented with consequences of advanced HIV. Fourteen of 16 of those who were not successfully engaged in care had ≥1 barrier to care (addiction, psychiatric disease, and/or homelessness).

CONCLUSIONS: A small number of HIV-infected individuals account for a high volume of acute unscheduled care. Intensive engagement in outpatient care may prevent some of this usage and ensuing costs.

© The Author(s) 2020. Published by Oxford University Press on behalf of Infectious Diseases Society of America.

Keywords: HIV; barriers to care; engagement in care; high-cost; high-need users; super utilizers

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• Journal Article